AI-Powered ECG Could Help Guide Lifelong Heart Monitoring

Researchers at the Mount Sinai Kravis Children’s Heart Center have spearheaded a multicenter effort to develop and validate an artificial intelligence (AI) tool that can analyze a standard electrocardiogram (ECG) to identify patients with repaired tetralogy of Fallot who may be at risk for harmful heart changes typically detected by cardiac MRI. Supported by the National Institutes of Health, the study was published in the European Heart Journal: Digital Health.

Tetralogy of Fallot is a congenital heart defect that requires surgical repair in childhood, but patients need lifelong monitoring to detect changes in heart size and function. Cardiac magnetic resonance imaging (MRI) is the gold-standard imaging test for this follow-up care but these scans are expensive, time-consuming, and not always easily accessible. Many patients miss recommended imaging.

In this multicenter study, investigators trained an AI model using ECG and MRI data from patients with repaired tetralogy of Fallot and validated the model across five additional hospitals in North America. The AI learned patterns in ECG signals linked to ventricular remodeling—changes in heart size and pumping function that can signal worsening health.

Key findings are as follows:

• AI plus ECG can estimate risk of ventricular remodeling. A quick, widely available test may help identify patients who need MRI sooner.
• There is potential to improve access and efficiency. The tool could help doctors prioritize MRI scans for higher-risk patients while safely delaying scans for lower-risk patients.
• Performance varied by hospital. Results highlight the importance of validating AI tools locally before clinical use.

“This research shows how artificial intelligence can unlock new value from a routine ECG,” said Son Duong, M.D., lead author and assistant professor of Pediatrics and Artificial Intelligence and Human Health at Icahn School of Medicine at Mount Sinai. “Our goal is to make lifelong heart monitoring more accessible and efficient for people born with congenital heart disease.”

The researchers claim the model is not intended to replace cardiac MRI but rather to help clinicians decide when imaging is most urgently needed.

“As AI becomes more integrated into health care, it is critical to rigorously validate these tools across diverse clinical settings,” said Girish Nadkarni, M.D., co-senior author and Barbara T. Murphy chair of the Windreich Department of Artificial Intelligence and Human Health at Mount Sinai Health System. “Our findings show both the promise of AI-enabled screening and the importance of testing performance at each site before real-world implementation.” Dr. Nadkarni is also the director of the Hasso Plattner Institute for Digital Health and chief AI officer, Icahn School of Medicine at Mount Sinai.

Patients with congenital heart disease often require lifelong specialized follow-up care. By combining AI with a simple ECG, the researchers hope to:

• Reduce unnecessary testing and healthcare costs
• Improve access to advanced imaging for patients who need it most
• Personalize follow-up care and improve long-term outcomes

The research team plans to test the AI-ECG approach in prospective clinical trials and refine the model for younger patients. They eventually hope to integrate the tool into routine clinical care.

Mount Sinai Health System is one of the largest academic medical systems in the New York metropolitan area, with 48,000 employees working across seven hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a school of medicine and graduate education. Mount Sinai tackles complex healthcare challenges such as discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. 

Through the integration of its hospitals, labs, and schools, Mount Sinai offers healthcare solutions from birth through geriatrics, leveraging approaches such as AI and informatics while keeping patients’ medical and emotional needs at the center of treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 10 free-standing joint-venture centers throughout New York City’s five boroughs, Westchester, Long Island, and Florida. Hospitals within the system are consistently ranked by Newsweek’s “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report’s “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report “Best Hospitals” Honor Roll for 2025-2026.