Introduction: Automated echocardiography image interpretation has the potential to transform clinical practice. However, neural networks developed in general cohorts may underperform in the setting of altered cardiac anatomy. Methods: Consecutive echocardiographic studies of patients with congenital or structural heart disease (C/SHD) were used to validate an existing convolutional neural network trained on 14,035 echocardiograms for automated view classification. In addition, a new convolutional neural network for view classification was trained and tested specifically in patients with C/SHD. Results: Overall, 9793 imaging files from 262 patients with C/SHD (mean age 49 years, 60% male) and 62 normal controls (mean age 45 years, 50.0% male) were included. Congenital diagnoses included among others, tetralogy of Fallot (30), Ebstein anomaly (18) and transposition of the great arteries (TGA, 48). Assessing correct view classification based on 284,250 individual frames revealed that the non-congenital model had an overall accuracy of 48.3% for correct view classification in patients with C/SHD compared to 66.7% in patients without cardiac disease. Our newly trained convolutional network for echocardiographic view detection based on over 139,910 frames and tested on 35,614 frames from C/SHD patients achieved an accuracy of 76.1% in detecting the correct echocardiographic view. Conclusions: The current study is the first to validate view classification by neural networks in C/SHD patients. While generic models have acceptable accuracy in general cardiology patients, the quality of image classification is only modest in patients with C/SHD. In contrast, our model trained in C/SHD achieved a considerably increased accuracy in this particular cohort.

Der Nutzen implantierbarer Defibrillatorsysteme zur Prävention des plötzlichen Herztods ist durch zahlreiche randomisierte Studien belegt. In Form des vollständig subkutan implantierbaren Kardioverter-Defibrillator-Systems (S-ICD) besteht die Option, einen entsprechenden Schutz zu gewährleisten und gleichzeitig die mit der transvenös implantierten Elektrode assoziierten Langzeitkomplikationen wie systemische Infektionen und Elektrodendysfunktion zu vermeiden. Mittlerweile ist die Sicherheit und Effektivität des S‑ICD durch Ergebnisse großer Registerstudien untermauert worden. Empfehlungen wurden, basierend auf der fehlenden Möglichkeit zur ventrikulären Stimulation, erstmals in die aktuellen Leitlinien aufgenommen. Perspektivisch wird die Problematik der durch Oversensing bedingten inadäquaten Schockabgaben mittels erweiterter Screening-Methoden und neuer Detektionsalgorithmen wahrscheinlich noch besser kontrolliert werden können. Außerdem scheint durch eine Kombination aus subkutanem ICD und LCP („leadless cardiac pacer“) in Zukunft die Kombination antibradykarder und antitachykarder ventrikulärer Stimulation realistisch. The use of transvenous implantable cardioverter–defibrillators (ICD) for the prevention of sudden cardiac death has been proven in numerous randomized trials. By using a totally subcutaneous ICD (S-ICD) system, it is expected to ensure appropriate protection while avoiding long-term complications associated with transvenous leads, such as systemic infection and electrode dysfunction. Meanwhile, the safety and effectiveness of the S‑ICD has been substantiated by results of large registry studies. Based on the missing option for ventricular stimulation, corresponding recommendations have been integrated into current guidelines for certain patient populations. In the future, the issue of inadequate shocks caused by oversensing may be solved using advanced screening tools and new detection algorithms. Furthermore, a combination of subcutaneous ICD and LCP (leadless cardiac pacer) seems realistic to enable antibradycardia and antitachycardia ventricular pacing.