Accurate ECG interpretation is vital, yet complex cardiac data and "black-box" AI models limit clinical utility. Inspired by Transformer architectures' success in NLP for understanding sequential data, we frame ECG as the heart's unique "language" of temporal patterns. We present CardioPatternFormer, a novel Transformer-based model for interpretable ECG classification. It employs a sophisticated attention mechanism to precisely identify and classify diverse cardiac patterns, excelling at discerning subtle anomalies and distinguishing multiple co-occurring conditions. This pattern-guided attention provides clear insights by highlighting influential signal regions, effectively allowing the "heart to talk" through transparent interpretations. CardioPatternFormer demonstrates robust performance on challenging ECGs, including complex multi-pathology cases. Its interpretability via attention maps enables clinicians to understand the model's rationale, fostering trust and aiding informed diagnostic decisions. This work offers a powerful, transparent solution for advanced ECG analysis, paving the way for more reliable and clinically actionable AI in cardiology.
Electrocardiogram (ECG) classification is crucial for automated cardiac disease diagnosis, yet existing methods often struggle to capture local morphological details and long-range temporal dependencies simultaneously. To address these challenges, we propose Cardioformer, a novel multi-granularity hybrid model that integrates cross-channel patching, hierarchical residual learning, and a two-stage self-attention mechanism. Cardioformer first encodes multi-scale token embeddings to capture fine-grained local features and global contextual information and then selectively fuses these representations through intra- and inter-granularity self-attention. Extensive evaluations on three benchmark ECG datasets under subject-independent settings demonstrate that model consistently outperforms four state-of-the-art baselines. Our Cardioformer model achieves the AUROC of 96.34$\pm$0.11, 89.99$\pm$0.12, and 95.59$\pm$1.66 in MIMIC-IV, PTB-XL and PTB dataset respectively outperforming PatchTST, Reformer, Transformer, and Medformer models. It also demonstrates strong cross-dataset generalization, achieving 49.18% AUROC on PTB and 68.41% on PTB-XL when trained on MIMIC-IV. These findings underscore the potential of Cardioformer to advance automated ECG analysis, paving the way for more accurate and robust cardiovascular disease diagnosis. We release the source code at https://github.com/KMobin555/Cardioformer.
Cardiovascular diseases (CVDs) remain the leading cause of mortality worldwide, highlighting the critical need for efficient and accurate diagnostic tools. Electrocardiograms (ECGs) are indispensable in diagnosing various heart conditions; however, their manual interpretation is time-consuming and error-prone. In this paper, we propose xLSTM-ECG, a novel approach that leverages an extended Long Short-Term Memory (xLSTM) network for multi-label classification of ECG signals, using the PTB-XL dataset. To the best of our knowledge, this work represents the first design and application of xLSTM modules specifically adapted for multi-label ECG classification. Our method employs a Short-Time Fourier Transform (STFT) to convert time-series ECG waveforms into the frequency domain, thereby enhancing feature extraction. The xLSTM architecture is specifically tailored to address the complexities of 12-lead ECG recordings by capturing both local and global signal features. Comprehensive experiments on the PTB-XL dataset reveal that our model achieves strong multi-label classification performance, while additional tests on the Georgia 12-Lead dataset underscore its robustness and efficiency. This approach significantly improves ECG classification accuracy, thereby advancing clinical diagnostics and patient care. The code will be publicly available upon acceptance.
Deep learning-based electrocardiogram (ECG) classification has shown impressive performance but clinical adoption has been slowed by the lack of transparent and faithful explanations. Post hoc methods such as saliency maps may fail to reflect a model's true decision process. Prototype-based reasoning offers a more transparent alternative by grounding decisions in similarity to learned representations of real ECG segments, enabling faithful, case-based explanations. We introduce ProtoECGNet, a prototype-based deep learning model for interpretable, multi-label ECG classification. ProtoECGNet employs a structured, multi-branch architecture that reflects clinical interpretation workflows: it integrates a 1D CNN with global prototypes for rhythm classification, a 2D CNN with time-localized prototypes for morphology-based reasoning, and a 2D CNN with global prototypes for diffuse abnormalities. Each branch is trained with a prototype loss designed for multi-label learning, combining clustering, separation, diversity, and a novel contrastive loss that encourages appropriate separation between prototypes of unrelated classes while allowing clustering for frequently co-occurring diagnoses. We evaluate ProtoECGNet on all 71 diagnostic labels from the PTB-XL dataset, demonstrating competitive performance relative to state-of-the-art black-box models while providing structured, case-based explanations. To assess prototype quality, we conduct a structured clinician review of the final model's projected prototypes, finding that they are rated as representative and clear. ProtoECGNet shows that prototype learning can be effectively scaled to complex, multi-label time-series classification, offering a practical path toward transparent and trustworthy deep learning models for clinical decision support.
A Notch Filter is essential in ECG signal processing to eliminate narrowband noise, especially powerline interference at 50 Hz or 60 Hz. This interference overlaps with vital ECG signal features, affecting the accuracy of downstream classification tasks (e.g., arrhythmia detection). A properly designed notch filter enhances signal quality, preserves essential ECG components (P, QRS, T waves), and improves the performance of machine learning or deep learning models used for ECG classification.
The classification of electrocardiogram (ECG) signals is crucial for early detection of arrhythmias and other cardiac conditions. However, despite advances in machine learning, many studies fail to follow standardization protocols, leading to inconsistencies in performance evaluation and real-world applicability. Additionally, hardware constraints essential for practical deployment, such as in pacemakers, Holter monitors, and wearable ECG patches, are often overlooked. Since real-world impact depends on feasibility in resource-constrained devices, ensuring efficient deployment is critical for continuous monitoring. This review systematically analyzes ECG classification studies published between 2017 and 2024, focusing on those adhering to the E3C (Embedded, Clinical, and Comparative Criteria), which include inter-patient paradigm implementation, compliance with Association for the Advancement of Medical Instrumentation (AAMI) recommendations, and model feasibility for embedded systems. While many studies report high accuracy, few properly consider patient-independent partitioning and hardware limitations. We identify state-of-the-art methods meeting E3C criteria and conduct a comparative analysis of accuracy, inference time, energy consumption, and memory usage. Finally, we propose standardized reporting practices to ensure fair comparisons and practical applicability of ECG classification models. By addressing these gaps, this study aims to guide future research toward more robust and clinically viable ECG classification systems.
DCentNet is a novel decentralized multistage signal classification approach designed for biomedical data from IoT wearable sensors, integrating early exit points (EEP) to enhance energy efficiency and processing speed. Unlike traditional centralized processing methods, which result in high energy consumption and latency, DCentNet partitions a single CNN model into multiple sub-networks using EEPs. By introducing encoder-decoder pairs at EEPs, the system compresses large feature maps before transmission, significantly reducing wireless data transfer and power usage. If an input is confidently classified at an EEP, processing stops early, optimizing efficiency. Initial sub-networks can be deployed on fog or edge devices to further minimize energy consumption. A genetic algorithm is used to optimize EEP placement, balancing performance and complexity. Experimental results on ECG classification show that with one EEP, DCentNet reduces wireless data transmission by 94.54% and complexity by 21%, while maintaining original accuracy and sensitivity. With two EEPs, sensitivity reaches 98.36%, accuracy 97.74%, wireless data transmission decreases by 91.86%, and complexity is reduced by 22%. Implemented on an ARM Cortex-M4 MCU, DCentNet achieves an average power saving of 73.6% compared to continuous wireless ECG transmission.
Machine learning has revolutionized biomedical signal analysis, particularly in electrocardiogram (ECG) classification. While convolutional neural networks (CNNs) excel at automatic feature extraction, the optimal integration of time- and frequency-domain information remains unresolved. This study introduces the Convolutional Fourier Analysis Network (CFAN), a novel architecture that unifies time-frequency analysis by embedding Fourier principles directly into CNN layers. We evaluate CFAN against four benchmarks - spectrogram-based 2D CNN (SPECT); 1D CNN (CNN1D); Fourier-based 1D CNN (FFT1D); and CNN1D with integrated Fourier Analysis Network (CNN1D-FAN) - across three ECG tasks: arrhythmia classification (MIT-BIH), identity recognition (ECG-ID), and apnea detection (Apnea-ECG). CFAN achieved state-of-the-art performance, surpassing all competing methods with accuracies of 98.95% (MIT-BIH), 96.83% (ECG-ID), and 95.01% (Apnea-ECG). Notably, on ECG-ID and Apnea-ECG, CFAN demonstrated statistically significant improvements over the second-best method (CNN1D-FAN, $p \leq 0.02$), further validating its superior performance. Key innovations include CONV-FAN blocks that combine sine, cosine and GELU activations in convolutional layers to capture periodic features and joint time-frequency learning without spectrogram conversion. Our results highlight CFAN's potential for broader biomedical and signal classification applications.
Spiking Neural Networks (SNNs) offer a biologically inspired computational paradigm, enabling energy-efficient data processing through spike-based information transmission. Despite notable advancements in hardware for SNNs, spike encoding has largely remained software-dependent, limiting efficiency. This paper addresses the need for adaptable and resource-efficient spike encoding hardware by presenting an area-optimized hardware implementation of the Spiketrum algorithm, which encodes time-varying analogue signals into spatiotemporal spike patterns. Unlike earlier performance-optimized designs, which prioritize speed, our approach focuses on reducing hardware footprint, achieving a 52% reduction in Block RAMs (BRAMs), 31% fewer Digital Signal Processing (DSP) slices, and a 6% decrease in Look-Up Tables (LUTs). The proposed implementation has been verified on an FPGA and successfully integrated into an IC using TSMC180 technology. Experimental results demonstrate the system's effectiveness in real-world applications, including sound and ECG classification. This work highlights the trade-offs between performance and resource efficiency, offering a flexible, scalable solution for neuromorphic systems in power-sensitive applications like cochlear implants and neural devices.
Electrocardiogram (ECG) analysis plays a crucial role in diagnosing cardiovascular diseases, but accurate interpretation of these complex signals remains challenging. This paper introduces a novel multimodal framework(GAF-FusionNet) for ECG classification that integrates time-series analysis with image-based representation using Gramian Angular Fields (GAF). Our approach employs a dual-layer cross-channel split attention module to adaptively fuse temporal and spatial features, enabling nuanced integration of complementary information. We evaluate GAF-FusionNet on three diverse ECG datasets: ECG200, ECG5000, and the MIT-BIH Arrhythmia Database. Results demonstrate significant improvements over state-of-the-art methods, with our model achieving 94.5\%, 96.9\%, and 99.6\% accuracy on the respective datasets. Our code will soon be available at https://github.com/Cross-Innovation-Lab/GAF-FusionNet.git.
The urgent need to promptly detect cardiac disorders from 12-lead Electrocardiograms using limited computations is motivated by the heart's fast and complex electrical activity and restricted computational power of portable devices. Timely and precise diagnoses are crucial since delays might significantly impact patient health outcomes. This research presents a novel deep-learning architecture that aims to diagnose heart abnormalities quickly and accurately. We devised a new activation function called aSoftMax, designed to improve the visibility of ECG deflections. The proposed activation function is used with Convolutional Neural Network architecture to includes kernel weight sharing across the ECG's various leads. This innovative method thoroughly generalizes the global 12-lead ECG features and minimizes the model's complexity by decreasing the trainable parameters. aSoftMax, combined with enhanced CNN architecture yielded AmpliNetECG12, we obtain exceptional accuracy of 84% in diagnosing cardiac disorders. AmpliNetECG12 shows outstanding prediction ability when used with the CPSC2018 dataset for arrhythmia classification. The model attains an F1-score of 80.71% and a ROC-AUC score of 96.00%, with 280,000 trainable parameters which signifies the lightweight yet efficient nature of AmpliNetECG12. The stochastic characteristics of aSoftMax, a fundamental element of AmpliNetECG12, improve prediction accuracy and also increasse the model's interpretability. This feature enhances comprehension of important ECG segments in different forms of arrhythmias, establishing a new standard of explainable architecture for cardiac disorder classification.
Electrocardiogram (ECG) captures the heart's electrical signals, offering valuable information for diagnosing cardiac conditions. However, the scarcity of labeled data makes it challenging to fully leverage supervised learning in medical domain. Self-supervised learning (SSL) offers a promising solution, enabling models to learn from unlabeled data and uncover meaningful patterns. In this paper, we show that masked modeling in the latent space can be a powerful alternative to existing self-supervised methods in the ECG domain. We introduce ECG-JEPA, a SSL model for 12-lead ECG analysis that learns semantic representations of ECG data by predicting in the hidden latent space, bypassing the need to reconstruct raw signals. This approach offers several advantages in the ECG domain: (1) it avoids producing unnecessary details, such as noise, which is common in ECG; and (2) it addresses the limitations of na\"ive L2 loss between raw signals. Another key contribution is the introduction of Cross-Pattern Attention (CroPA), a specialized masked attention mechanism tailored for 12-lead ECG data. ECG-JEPA is trained on the union of several open ECG datasets, totaling approximately 180,000 samples, and achieves state-of-the-art performance in various downstream tasks including ECG classification and feature prediction. Our code is openly available at https://github.com/sehunfromdaegu/ECG_JEPA.
An electrocardiogram (ECG) captures the heart's electrical signal to assess various heart conditions. In practice, ECG data is stored as either digitized signals or printed images. Despite the emergence of numerous deep learning models for digitized signals, many hospitals prefer image storage due to cost considerations. Recognizing the unavailability of raw ECG signals in many clinical settings, we propose VizECGNet, which uses only printed ECG graphics to determine the prognosis of multiple cardiovascular diseases. During training, cross-modal attention modules (CMAM) are used to integrate information from two modalities - image and signal, while self-modality attention modules (SMAM) capture inherent long-range dependencies in ECG data of each modality. Additionally, we utilize knowledge distillation to improve the similarity between two distinct predictions from each modality stream. This innovative multi-modal deep learning architecture enables the utilization of only ECG images during inference. VizECGNet with image input achieves higher performance in precision, recall, and F1-Score compared to signal-based ECG classification models, with improvements of 3.50%, 8.21%, and 7.38%, respectively.
Multi-channel ECG-based cardiac disorders detection has an impact on cardiac care and treatment. Limitations of existing methods included variation in ECG waveforms due to the location of electrodes, high non-linearity in the signal, and amplitude measurement in millivolts. The present study reports a non-linear analysis-based methodology that utilizes Recurrence plot visualization. The patterned occurrence of well-defined structures, such as the QRS complex, can be exploited effectively using Recurrence plots. This Recurrence-based method is applied to the publicly available Physikalisch-Technische Bundesanstalt (PTB) dataset from PhysioNet database, where we studied four classes of different cardiac disorders (Myocardial infarction, Bundle branch blocks, Cardiomyopathy, and Dysrhythmia) and healthy controls, achieving an impressive classification accuracy of 100%. Additionally, t-SNE plot visualizations of the latent space embeddings derived from Recurrence plots and Recurrence Quantification Analysis features reveal a clear demarcation between the considered cardiac disorders and healthy individuals, demonstrating the potential of this approach.
Electrocardiograms (ECG), which record the electrophysiological activity of the heart, have become a crucial tool for diagnosing these diseases. In recent years, the application of deep learning techniques has significantly improved the performance of ECG signal classification. Multi-resolution feature analysis, which captures and processes information at different time scales, can extract subtle changes and overall trends in ECG signals, showing unique advantages. However, common multi-resolution analysis methods based on simple feature addition or concatenation may lead to the neglect of low-resolution features, affecting model performance. To address this issue, this paper proposes the Multi-Resolution Mutual Learning Network (MRM-Net). MRM-Net includes a dual-resolution attention architecture and a feature complementary mechanism. The dual-resolution attention architecture processes high-resolution and low-resolution features in parallel. Through the attention mechanism, the high-resolution and low-resolution branches can focus on subtle waveform changes and overall rhythm patterns, enhancing the ability to capture critical features in ECG signals. Meanwhile, the feature complementary mechanism introduces mutual feature learning after each layer of the feature extractor. This allows features at different resolutions to reinforce each other, thereby reducing information loss and improving model performance and robustness. Experiments on the PTB-XL and CPSC2018 datasets demonstrate that MRM-Net significantly outperforms existing methods in multi-label ECG classification performance. The code for our framework will be publicly available at https://github.com/wxhdf/MRM.
Electrocardiogram (ECG) signal analysis represents a pivotal technique in the diagnosis of cardiovascular diseases. Although transformer-based models have made significant progress in ECG classification, they exhibit inefficiencies in the inference phase. The issue is primarily attributable to the secondary computational complexity of Transformer's self-attention mechanism. particularly when processing lengthy sequences. To address this issue, we propose a novel model, ECGMamba, which employs a bidirectional state-space model (BiSSM) to enhance classification efficiency. ECGMamba is based on the innovative Mamba-based block, which incorporates a range of time series modeling techniques to enhance performance while maintaining the efficiency of inference. The experimental results on two publicly available ECG datasets demonstrate that ECGMamba effectively balances the effectiveness and efficiency of classification, achieving competitive performance. This study not only contributes to the body of knowledge in the field of ECG classification but also provides a new research path for efficient and accurate ECG signal analysis. This is of guiding significance for the development of diagnostic models for cardiovascular diseases.
Heart disease is one of the leading causes of death worldwide. Given its high risk and often asymptomatic nature, real-time continuous monitoring is essential. Unlike traditional artificial neural networks (ANNs), spiking neural networks (SNNs) are well-known for their energy efficiency, making them ideal for wearable devices and energy-constrained edge computing platforms. However, current energy measurement of SNN implementations for detecting heart diseases typically rely on empirical values, often overlooking hardware overhead. Additionally, the integer and fire activations in SNNs require multiple memory accesses and repeated computations, which can further compromise energy efficiency. In this paper, we propose sparrowSNN, a redesign of the standard SNN workflow from a hardware perspective, and present a dedicated ASIC design for SNNs, optimized for ultra-low power wearable devices used in heartbeat classification. Using the MIT-BIH dataset, our SNN achieves a state-of-the-art accuracy of 98.29% for SNNs, with energy consumption of 31.39nJ per inference and power usage of 6.1uW, making sparrowSNN the highest accuracy with the lowest energy use among comparable systems. We also compare the energy-to-accuracy trade-offs between SNNs and quantized ANNs, offering recommendations on insights on how best to use SNNs.
Common artefacts such as baseline drift, rescaling, and noise critically limit the performance of machine learningbased automated ECG analysis and interpretation. This study proposes Derived Peak (DP) encoding, a non-parametric method that generates signed spikes corresponding to zero crossings of the signals first and second-order time derivatives. Notably, DP encoding is invariant to shift and scaling artefacts, and its implementation is further simplified by the absence of userdefined parameters. DP encoding was used to encode the 12-lead ECG data from the PTB-XL dataset (n=18,869 participants) and was fed to 1D-ResNet-18 models trained to identify myocardial infarction, conductive deficits and ST-segment abnormalities. Robustness to artefacts was assessed by corrupting ECG data with sinusoidal baseline drift, shift, rescaling and noise, before encoding. The addition of these artefacts resulted in a significant drop in accuracy for seven other methods from prior art, while DP encoding maintained a baseline AUC of 0.88 under drift, shift and rescaling. DP achieved superior performance to unencoded inputs in the presence of shift (AUC under 1mV shift: 0.91 vs 0.62), and rescaling artefacts (AUC 0.91 vs 0.79). Thus, DP encoding is a simple method by which robustness to common ECG artefacts may be improved for automated ECG analysis and interpretation.
This research paper explores ways to apply Federated Learning (FL) and Differential Privacy (DP) techniques to population-scale Electrocardiogram (ECG) data. The study learns a multi-label ECG classification model using FL and DP based on 1,565,849 ECG tracings from 7 hospitals in Alberta, Canada. The FL approach allowed collaborative model training without sharing raw data between hospitals while building robust ECG classification models for diagnosing various cardiac conditions. These accurate ECG classification models can facilitate the diagnoses while preserving patient confidentiality using FL and DP techniques. Our results show that the performance achieved using our implementation of the FL approach is comparable to that of the pooled approach, where the model is trained over the aggregating data from all hospitals. Furthermore, our findings suggest that hospitals with limited ECGs for training can benefit from adopting the FL model compared to single-site training. In addition, this study showcases the trade-off between model performance and data privacy by employing DP during model training. Our code is available at https://github.com/vikhyatt/Hospital-FL-DP.
Traditionally, machine learning-based clinical prediction models have been trained and evaluated on patient data from a single source, such as a hospital. Cross-validation methods can be used to estimate the accuracy of such models on new patients originating from the same source, by repeated random splitting of the data. However, such estimates tend to be highly overoptimistic when compared to accuracy obtained from deploying models to sources not represented in the dataset, such as a new hospital. The increasing availability of multi-source medical datasets provides new opportunities for obtaining more comprehensive and realistic evaluations of expected accuracy through source-level cross-validation designs. In this study, we present a systematic empirical evaluation of standard K-fold cross-validation and leave-source-out cross-validation methods in a multi-source setting. We consider the task of electrocardiogram based cardiovascular disease classification, combining and harmonizing the openly available PhysioNet CinC Challenge 2021 and the Shandong Provincial Hospital datasets for our study. Our results show that K-fold cross-validation, both on single-source and multi-source data, systemically overestimates prediction performance when the end goal is to generalize to new sources. Leave-source-out cross-validation provides more reliable performance estimates, having close to zero bias though larger variability. The evaluation highlights the dangers of obtaining misleading cross-validation results on medical data and demonstrates how these issues can be mitigated when having access to multi-source data.