ECG-aBcDe: Overcoming Model Dependence, Encoding ECG into a Universal Language for Any LLM

Large Language Models (LLMs) hold significant promise for electrocardiogram (ECG) analysis, yet challenges remain regarding transferability, time-scale information learning, and interpretability. Current methods suffer from model-specific ECG encoders, hindering transfer across LLMs. Furthermore, LLMs struggle to capture crucial time-scale information inherent in ECGs due to Transformer limitations. And their black-box nature limits clinical adoption. To address these limitations, we introduce ECG-aBcDe, a novel ECG encoding method that transforms ECG signals into a universal ECG language readily interpretable by any LLM. By constructing a hybrid dataset of ECG language and natural language, ECG-aBcDe enables direct fine-tuning of pre-trained LLMs without architectural modifications, achieving "construct once, use anywhere" capability. Moreover, the bidirectional convertibility between ECG and ECG language of ECG-aBcDe allows for extracting attention heatmaps from ECG signals, significantly enhancing interpretability. Finally, ECG-aBcDe explicitly represents time-scale information, mitigating Transformer limitations. This work presents a new paradigm for integrating ECG analysis with LLMs. Compared with existing methods, our method achieves competitive performance on ROUGE-L and METEOR. Notably, it delivers significant improvements in the BLEU-4, with improvements of 2.8 times and 3.9 times in in-dataset and cross-dataset evaluations, respectively, reaching scores of 42.58 and 30.76. These results provide strong evidence for the feasibility of the new paradigm.

Bridging Performance Gaps for Foundation Models: A Post-Training Strategy for ECGFounder

ECG foundation models are increasingly popular due to their adaptability across various tasks. However, their clinical applicability is often limited by performance gaps compared to task-specific models, even after pre-training on large ECG datasets and fine-tuning on target data. This limitation is likely due to the lack of an effective post-training strategy. In this paper, we propose a simple yet effective post-training approach to enhance ECGFounder, a state-of-the-art ECG foundation model pre-trained on over 7 million ECG recordings. Experiments on the PTB-XL benchmark show that our approach improves the baseline fine-tuning strategy by 1.2%-3.3% in macro AUROC and 5.3%-20.9% in macro AUPRC. Additionally, our method outperforms several recent state-of-the-art approaches, including task-specific and advanced architectures. Further evaluation reveals that our method is more stable and sample-efficient compared to the baseline, achieving a 9.1% improvement in macro AUROC and a 34.9% improvement in macro AUPRC using just 10% of the training data. Ablation studies identify key components, such as stochastic depth and preview linear probing, that contribute to the enhanced performance. These findings underscore the potential of post-training strategies to improve ECG foundation models, and we hope this work will contribute to the continued development of foundation models in the ECG domain.

FoundationalECGNet: A Lightweight Foundational Model for ECG-based Multitask Cardiac Analysis

Cardiovascular diseases (CVDs) remain a leading cause of mortality worldwide, underscoring the importance of accurate and scalable diagnostic systems. Electrocardiogram (ECG) analysis is central to detecting cardiac abnormalities, yet challenges such as noise, class imbalance, and dataset heterogeneity limit current methods. To address these issues, we propose FoundationalECGNet, a foundational framework for automated ECG classification. The model integrates a dual-stage denoising by Morlet and Daubechies wavelets transformation, Convolutional Block Attention Module (CBAM), Graph Attention Networks (GAT), and Time Series Transformers (TST) to jointly capture spatial and temporal dependencies in multi-channel ECG signals. FoundationalECGNet first distinguishes between Normal and Abnormal ECG signals, and then classifies the Abnormal signals into one of five cardiac conditions: Arrhythmias, Conduction Disorders, Myocardial Infarction, QT Abnormalities, or Hypertrophy. Across multiple datasets, the model achieves a 99% F1-score for Normal vs. Abnormal classification and shows state-of-the-art performance in multi-class disease detection, including a 99% F1-score for Conduction Disorders and Hypertrophy, as well as a 98.9% F1-score for Arrhythmias. Additionally, the model provides risk level estimations to facilitate clinical decision-making. In conclusion, FoundationalECGNet represents a scalable, interpretable, and generalizable solution for automated ECG analysis, with the potential to improve diagnostic precision and patient outcomes in healthcare settings. We'll share the code after acceptance.

Domain Knowledge is Power: Leveraging Physiological Priors for Self Supervised Representation Learning in Electrocardiography

Objective: Electrocardiograms (ECGs) play a crucial role in diagnosing heart conditions; however, the effectiveness of artificial intelligence (AI)-based ECG analysis is often hindered by the limited availability of labeled data. Self-supervised learning (SSL) can address this by leveraging large-scale unlabeled data. We introduce PhysioCLR (Physiology-aware Contrastive Learning Representation for ECG), a physiology-aware contrastive learning framework that incorporates domain-specific priors to enhance the generalizability and clinical relevance of ECG-based arrhythmia classification. Methods: During pretraining, PhysioCLR learns to bring together embeddings of samples that share similar clinically relevant features while pushing apart those that are dissimilar. Unlike existing methods, our method integrates ECG physiological similarity cues into contrastive learning, promoting the learning of clinically meaningful representations. Additionally, we introduce ECG- specific augmentations that preserve the ECG category post augmentation and propose a hybrid loss function to further refine the quality of learned representations. Results: We evaluate PhysioCLR on two public ECG datasets, Chapman and Georgia, for multilabel ECG diagnoses, as well as a private ICU dataset labeled for binary classification. Across the Chapman, Georgia, and private cohorts, PhysioCLR boosts the mean AUROC by 12% relative to the strongest baseline, underscoring its robust cross-dataset generalization. Conclusion: By embedding physiological knowledge into contrastive learning, PhysioCLR enables the model to learn clinically meaningful and transferable ECG eatures. Significance: PhysioCLR demonstrates the potential of physiology-informed SSL to offer a promising path toward more effective and label-efficient ECG diagnostics.

Autoencoder-Based Denoising of Muscle Artifacts in ECG to Preserve Skin Nerve Activity (SKNA) for Cognitive Stress Detection

The sympathetic nervous system (SNS) plays a central role in regulating the body's responses to stress and maintaining physiological stability. Its dysregulation is associated with a wide range of conditions, from cardiovascular disease to anxiety disorders. Skin nerve activity (SKNA) extracted from high-frequency electrocardiogram (ECG) recordings provides a noninvasive window into SNS dynamics, but its measurement is highly susceptible to electromyographic (EMG) contamination. Traditional preprocessing based on bandpass filtering within a fixed range (e.g., 500--1000 Hz) is susceptible to overlapping EMG and SKNA spectral components, especially during sustained muscle activity. We present a denoising approach using a lightweight one-dimensional convolutional autoencoder with a long short-term memory (LSTM) bottleneck to reconstruct clean SKNA from EMG-contaminated recordings. Using clean ECG-derived SKNA data from cognitive stress experiments and EMG noise from chaotic muscle stimulation recordings, we simulated contamination at realistic noise levels (--4 dB, --8 dB signal-to-noise ratio) and trained the model in the leave-one-subject-out cross-validation framework. The method improved signal-to-noise ratio by up to 9.65 dB, increased cross correlation with clean SKNA from 0.40 to 0.72, and restored burst-based SKNA features to near-clean discriminability (AUROC $\geq$ 0.96). Classification of baseline versus sympathetic stimulation (cognitive stress) conditions reached accuracies of 91--98\% across severe noise levels, comparable to clean data. These results demonstrate that deep learning--based reconstruction can preserve physiologically relevant sympathetic bursts during substantial EMG interference, enabling more robust SKNA monitoring in naturalistic, movement-rich environments.

Machine Intelligence on the Edge: Interpretable Cardiac Pattern Localisation Using Reinforcement Learning

Matched filters are widely used to localise signal patterns due to their high efficiency and interpretability. However, their effectiveness deteriorates for low signal-to-noise ratio (SNR) signals, such as those recorded on edge devices, where prominent noise patterns can closely resemble the target within the limited length of the filter. One example is the ear-electrocardiogram (ear-ECG), where the cardiac signal is attenuated and heavily corrupted by artefacts. To address this, we propose the Sequential Matched Filter (SMF), a paradigm that replaces the conventional single matched filter with a sequence of filters designed by a Reinforcement Learning agent. By formulating filter design as a sequential decision-making process, SMF adaptively design signal-specific filter sequences that remain fully interpretable by revealing key patterns driving the decision-making. The proposed SMF framework has strong potential for reliable and interpretable clinical decision support, as demonstrated by its state-of-the-art R-peak detection and physiological state classification performance on two challenging real-world ECG datasets. The proposed formulation can also be extended to a broad range of applications that require accurate pattern localisation from noise-corrupted signals.

Comprehensive Signal Quality Evaluation of a Wearable Textile ECG Garment: A Sex-Balanced Study

We introduce a novel wearable textile-garment featuring an innovative electrode placement aimed at minimizing noise and motion artifacts, thereby enhancing signal fidelity in Electrocardiography (ECG) recordings. We present a comprehensive, sex-balanced evaluation involving 15 healthy males and 15 healthy female participants to ensure the device's suitability across anatomical and physiological variations. The assessment framework encompasses distinct evaluation approaches: quantitative signal quality indices to objectively benchmark device performance; rhythm-based analyzes of physiological parameters such as heart rate and heart rate variability; machine learning classification tasks to assess application-relevant predictive utility; morphological analysis of ECG features including amplitude and interval parameters; and investigations of the effects of electrode projection angle given by the textile / body shape, with all analyzes stratified by sex to elucidate sex-specific influences. Evaluations were conducted across various activity phases representing real-world conditions. The results demonstrate that the textile system achieves signal quality highly concordant with reference devices in both rhythm and morphological analyses, exhibits robust classification performance, and enables identification of key sex-specific determinants affecting signal acquisition. These findings underscore the practical viability of textile-based ECG garments for physiological monitoring as well as psychophysiological state detection. Moreover, we identify the importance of incorporating sex-specific design considerations to ensure equitable and reliable cardiac diagnostics in wearable health technologies.

Explainable AI (XAI) for Arrhythmia detection from electrocardiograms

Advancements in deep learning have enabled highly accurate arrhythmia detection from electrocardiogram (ECG) signals, but limited interpretability remains a barrier to clinical adoption. This study investigates the application of Explainable AI (XAI) techniques specifically adapted for time-series ECG analysis. Using the MIT-BIH arrhythmia dataset, a convolutional neural network-based model was developed for arrhythmia classification, with R-peak-based segmentation via the Pan-Tompkins algorithm. To increase the dataset size and to reduce class imbalance, an additional 12-lead ECG dataset was incorporated. A user needs assessment was carried out to identify what kind of explanation would be preferred by medical professionals. Medical professionals indicated a preference for saliency map-based explanations over counterfactual visualisations, citing clearer correspondence with ECG interpretation workflows. Four SHapley Additive exPlanations (SHAP)-based approaches: permutation importance, KernelSHAP, gradient-based methods, and Deep Learning Important FeaTures (DeepLIFT), were implemented and compared. The model achieved 98.3% validation accuracy on MIT-BIH but showed performance degradation on the combined dataset, underscoring dataset variability challenges. Permutation importance and KernelSHAP produced cluttered visual outputs, while gradient-based and DeepLIFT methods highlighted waveform regions consistent with clinical reasoning, but with variability across samples. Findings emphasize the need for domain-specific XAI adaptations in ECG analysis and highlight saliency mapping as a more clinically intuitive approach

Learning ECG Representations via Poly-Window Contrastive Learning

Electrocardiogram (ECG) analysis is foundational for cardiovascular disease diagnosis, yet the performance of deep learning models is often constrained by limited access to annotated data. Self-supervised contrastive learning has emerged as a powerful approach for learning robust ECG representations from unlabeled signals. However, most existing methods generate only pairwise augmented views and fail to leverage the rich temporal structure of ECG recordings. In this work, we present a poly-window contrastive learning framework. We extract multiple temporal windows from each ECG instance to construct positive pairs and maximize their agreement via statistics. Inspired by the principle of slow feature analysis, our approach explicitly encourages the model to learn temporally invariant and physiologically meaningful features that persist across time. We validate our approach through extensive experiments and ablation studies on the PTB-XL dataset. Our results demonstrate that poly-window contrastive learning consistently outperforms conventional two-view methods in multi-label superclass classification, achieving higher AUROC (0.891 vs. 0.888) and F1 scores (0.680 vs. 0.679) while requiring up to four times fewer pre-training epochs (32 vs. 128) and 14.8% in total wall clock pre-training time reduction. Despite processing multiple windows per sample, we achieve a significant reduction in the number of training epochs and total computation time, making our method practical for training foundational models. Through extensive ablations, we identify optimal design choices and demonstrate robustness across various hyperparameters. These findings establish poly-window contrastive learning as a highly efficient and scalable paradigm for automated ECG analysis and provide a promising general framework for self-supervised representation learning in biomedical time-series data.

Biomedical Signal Processing: EEG and ECG Classification with Discrete Wavelet Transforms, Energy Distribution, and Convolutional Neural Networks

Biomedical signal processing extract meaningful information from physiological signals like electrocardiograms (ECGs), electroencephalograms (EEGs), and electromyograms (EMGs) to diagnose, monitor, and treat medical conditions and diseases such as seizures, cardiomyopathy, and neuromuscular disorders, respectively. Traditional manual physician analysis of electrical recordings is prone to human error as subtle anomolies may not be detected. Recently, advanced deep learning has significantly improved the accuracy of biomedical signal analysis. A multi-modal deep learning model is proposed that utilizes discrete wavelet transforms for signal pre-processing to reduce noise. A multi-modal image fusion and multimodal feature fusion framework is utilized that converts numeric biomedical signals into 2D and 3D images for image processing using Gramian angular fields, recurrency plots, and Markov transition fields. In this paper, deep learning models are applied to ECG, EEG, and human activity signals using actual medical datasets, brain, and heart recordings. The results demonstrate that using a multi-modal approach using wavelet transforms improves the accuracy of disease and disorder classification.