Arrhythmias & electrophysiology
Local Conformal Auditing Exposes and Restores Reliability of AI-ECG Atrial Fibrillation Detection Under External Deployment Shift
Authors' conclusion
AI-ECG uncertainty can fail silently despite high AUC. A local conformal audit detects when uncertainty estimates are untrustworthy and recalibrates the uncertainty layer without changing the classifier, converting trust into a measurable, subgroup-aware, task-specific guarantee.
Study context
- Population
- 12-lead ECGs from a German training source (PTB-XL) and external Chinese (Chapman-Shaoxing) and US (Georgia) cohortsECGs per cohort · PTB-XL (Germany; training, ECGs) 7,831 · PTB-XL (Germany; patients) 7,164 · Chinese (Chapman-Shaoxing) 2,289 · US (Georgia) 1,990
- Target condition
- atrial fibrillation (AF)
Methodological detailsexternal deployment shift, 90%-target split-conformal coverage, local labeled audit without retraining
- External deployment shift
- 90%-target split-conformal coverage
- Local labeled audit without retraining
Performance
As reported in the abstract
| Test or model | Atrial fibrillation (AF) AUC |
|---|---|
| China (Chapman-Shaoxing) | 0.998 (95% CI 0.997-0.999) |
| US (Georgia) | 0.936 (0.919-0.952) |
Atrial fibrillation (AF) AUC
China (Chapman-Shaoxing)0.998 (95% CI 0.997-0.999)
US (Georgia)0.936 (0.919-0.952)
Further findings
| Outcome | Chinese men | Chinese women | Difference (95% CI) | |
|---|---|---|---|---|
| Coverage in Chinese cohort by sex (subgroup)Coverage lower in men | 0.707 | 0.822 | 0.115 (0.081–0.148) | |
| −0.100.10.2Difference (linear scale) |
Expected calibration error (ECE)
- ECE, source
- 0.051
- ECE, external cohorts
- 0.197 and 0.237
Source-calibrated conformal coverage
- Coverage, source
- 0.901
- Coverage, external cohorts
- 0.758 and 0.722
- Both P<0.001
Label-free shift corrections
- Label-free corrections failed
Coverage after local recalibration
- Mean coverage with 50 labeled ECGs
- 0.90
- 95% simulation interval, 50 ECGs
- 0.82-0.97
- 95% simulation interval, 200 ECGs
- 0.86-0.94
AF auto-clear with local risk control
- Held-out ECGs certified for auto-clearing, China
- 68%
- US cohort: abstained
Original publication
Local Conformal Auditing Exposes and Restores Reliability of AI-ECG Atrial Fibrillation Detection Under External Deployment Shift. Heart Rhythm. Published 4 November 2026. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →