OpenEP|NET

Context Atrial fibrillation (AF) is a disorder of the heart rhythm which becomes more common with age, increases risks of stroke and reduces quality of life. It affects ~25% of people during their lives. Although AF has been recognised for over 100 years, treatments for AF are frequently unsuccessful. AF can be treated by a procedure called ablation, in which parts of the heart are cauterised. However, ablation is only successful in preventing AF from coming back in 50-80% of patients. We also don't know how, or even if, ablation influences long term health. During ablation, large amounts of data are collected: up to 15Gb per patient, equivalent to >20 hours of video. This data describes the shape and electrical function of the heart. There is an opportunity to use data routinely collected from a first procedure to help decide what to do later, for example, if AF returns. There is also emerging evidence showing how these data can be used for diagnostic purposes, outwith ablation settings. However, until now there has been no way to analyse these data across large groups of patients. Unlike medical imaging data, electrophysiology data is not stored in central databases and manufacturer-specific file formats have limited analysis at scale. AF research has therefore fallen behind other fields in the use of "big data" and artificial intelligence. Recently, we released the Open Electrophysiology Framework for Research (OpenEP), which reduces electrophysiology/ablation data from 15Gb down to approximately 20Mb - equivalent to about 5 songs of data - per patient. This advance means that the data are now readily accessible for analysis across large groups of thousands of patients with AF. Aims and objectives Here, we seek to establish a nationwide cohort study, with international validation. We will combine our novel platform for extracting markers of atrial health from routine data with a bespoke study app and national data linkage. We will establish a clinical research network, called OpenEP|NET, to address important challenges in the management of AF. In this project, we initially study a sample of 2,300 AF patients to understand who will benefit from AF ablation in three areas: ablation response, patient reported outcomes and cardiovascular outcomes. Ablation response describes whether AF gets better after an ablation procedure. Patient reported outcomes are some of the key things that matter to patients such as quality of life or AF symptoms. Cardiovascular outcomes are the future problems, like stroke, that can lead to long-term consequences. Potential applications and benefits This project will develop algorithms for predicting outcomes and provide the data to support future randomised trials of these technologies. We will engage with patients, funders and the wider public to plan subsequent and wide-reaching clinical studies to test the clinical effectiveness of the algorithms developed here. OpenEP|NET will also begin a new future for electrophysiology research. An important consideration is planning for this future and co-ordination amongst centres. An important part of this project will therefore be focussed on making sure that the right technologies, know-how, infrastructure, access and resources are in place to allow other researchers to make use of OpenEP|NET in the future, both nationally and internationally.