Arrhythmias & electrophysiology
Artificial intelligence-enabled electrocardiographic sex discordance and the risk of incident atrial fibrillation: A multinational cohort study
Authors' conclusion
The AI-ECG sex discordance score captures females with disproportionately elevated AF risk
Study context
- Population
- Atrial fibrillation (AF)-free individuals in 3 test sets (Severance Hospital, Yongin Severance Hospital, UK Biobank)
- Exposure
- Higher vs lower AI-ECG sex discordance score
- Outcome
- Incident AF
Methodological detailsexternal validation, 3 test sets
- External validation
- 3 test sets
Main finding
As reported in the abstract
Incident AF per SD increase in sex discordance score, females
Hazard ratio per SD (95% CI)
Severance Hospital, females
1.28(1.24–1.33)
Yongin Severance Hospital, females
1.32(1.27–1.36)
UK Biobank, females
1.23(1.13–1.32)
Per SD increase in sex discordance score, as printed
Observational data: associations, not effects.
Further findings
Discrimination for AF: C-index increase adding sex discordance score to Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation (CHARGE-AF) model, in females
| C-index increase (95% CI) | ||
|---|---|---|
| Females | 0.026 (0.013–0.037) | |
| Females | 0.020 (0.010–0.032) | |
| −0.0200.020.04Difference (linear scale) |
UK Biobank test set, females: sex discordance score and incident AF
| CHARGE-AF-adjusted HR per SD (95% CI) | ||
|---|---|---|
| Females | 1.23 (1.13–1.32) | |
| 0.512CHARGE-AF-adjusted HR per SD (log scale) |
| C-index increase (95% CI) | ||
|---|---|---|
| Females | 0.024 (0.005–0.040) | |
| −0.0200.020.040.06Difference (linear scale) |
- Discrimination for AF: C-index increase adding sex discordance score to CHARGE-AF model, in females: in the respective datasets (Severance Hospital, Yongin Severance Hospital test sets)
Discrimination for AF: C-index increase adding sex discordance score to CHARGE-AF model, in females
- No significant improvement in males
Correlates of sex discordance score in females
- Correlated with sex hormone imbalance, pericardial and visceral adiposity, atrial remodeling and adverse lifestyle factors
Original publication
Artificial intelligence-enabled electrocardiographic sex discordance and the risk of incident atrial fibrillation: A multinational cohort study. Heart Rhythm. Published 5 December 2025. doi:10.
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