ECGFlowCMR: Pretraining with ECG-Generated Cine CMR Improves Cardiac Disease Classification and Phenotype Prediction

Cardiac Magnetic Resonance (CMR) imaging provides a comprehensive assessment of cardiac structure and function but remains constrained by high acquisition costs and reliance on expert annotations, limiting the availability of large-scale labeled datasets. In contrast, electrocardiograms (ECGs) are inexpensive, widely accessible, and offer a promising modality for conditioning the generative synthesis of cine CMR. To this end, we propose ECGFlowCMR, a novel ECG-to-CMR generative framework that integrates a Phase-Aware Masked Autoencoder (PA-MAE) and an Anatomy-Motion Disentangled Flow (AMDF) to address two fundamental challenges: (1) the cross-modal temporal mismatch between multi-beat ECG recordings and single-cycle CMR sequences, and (2) the anatomical observability gap due to the limited structural information inherent in ECGs. Extensive experiments on the UK Biobank and a proprietary clinical dataset demonstrate that ECGFlowCMR can generate realistic cine CMR sequences from ECG inputs, enabling scalable pretraining and improving performance on downstream cardiac disease classification and phenotype prediction tasks.

ECG-Agent: On-Device Tool-Calling Agent for ECG Multi-Turn Dialogue

Recent advances in Multimodal Large Language Models have rapidly expanded to electrocardiograms, focusing on classification, report generation, and single-turn QA tasks. However, these models fall short in real-world scenarios, lacking multi-turn conversational ability, on-device efficiency, and precise understanding of ECG measurements such as the PQRST intervals. To address these limitations, we introduce ECG-Agent, the first LLM-based tool-calling agent for multi-turn ECG dialogue. To facilitate its development and evaluation, we also present ECG-Multi-Turn-Dialogue (ECG-MTD) dataset, a collection of realistic user-assistant multi-turn dialogues for diverse ECG lead configurations. We develop ECG-Agents in various sizes, from on-device capable to larger agents. Experimental results show that ECG-Agents outperform baseline ECG-LLMs in response accuracy. Furthermore, on-device agents achieve comparable performance to larger agents in various evaluations that assess response accuracy, tool-calling ability, and hallucinations, demonstrating their viability for real-world applications.

How Much Temporal Modeling is Enough? A Systematic Study of Hybrid CNN-RNN Architectures for Multi-Label ECG Classification

Accurate multi-label classification of electrocardiogram (ECG) signals remains challenging due to the coexistence of multiple cardiac conditions, pronounced class imbalance, and long-range temporal dependencies in multi-lead recordings. Although recent studies increasingly rely on deep and stacked recurrent architectures, the necessity and clinical justification of such architectural complexity have not been rigorously examined. In this work, we perform a systematic comparative evaluation of convolutional neural networks (CNNs) combined with multiple recurrent configurations, including LSTM, GRU, Bidirectional LSTM (BiLSTM), and their stacked variants, for multi-label ECG classification on the PTB-XL dataset comprising 23 diagnostic categories. The CNN component serves as a morphology-driven baseline, while recurrent layers are progressively integrated to assess their contribution to temporal modeling and generalization performance. Experimental results indicate that a CNN integrated with a single BiLSTM layer achieves the most favorable trade-off between predictive performance and model complexity. This configuration attains superior Hamming loss (0.0338), macro-AUPRC (0.4715), micro-F1 score (0.6979), and subset accuracy (0.5723) compared with deeper recurrent combinations. Although stacked recurrent models occasionally improve recall for specific rare classes, our results provide empirical evidence that increasing recurrent depth yields diminishing returns and may degrade generalization due to reduced precision and overfitting. These findings suggest that architectural alignment with the intrinsic temporal structure of ECG signals, rather than increased recurrent depth, is a key determinant of robust performance and clinically relevant deployment.

Beat-ssl: Capturing Local ECG Morphology through Heartbeat-level Contrastive Learning with Soft Targets

Obtaining labelled ECG data for developing supervised models is challenging. Contrastive learning (CL) has emerged as a promising pretraining approach that enables effective transfer learning with limited labelled data. However, existing CL frameworks either focus solely on global context or fail to exploit ECG-specific characteristics. Furthermore, these methods rely on hard contrastive targets, which may not adequately capture the continuous nature of feature similarity in ECG signals. In this paper, we propose Beat-SSL, a contrastive learning framework that performs dual-context learning through both rhythm-level and heartbeat-level contrasting with soft targets. We evaluated our pretrained model on two downstream tasks: 1) multilabel classification for global rhythm assessment, and 2) ECG segmentation to assess its capacity to learn representations across both contexts. We conducted an ablation study and compared the best configuration with three other methods, including one ECG foundation model. Despite the foundation model's broader pretraining, Beat-SSL reached 93% of its performance in multilabel classification task and surpassed all other methods in the segmentation task by 4%.

Inter-patient ECG Arrhythmia Classification with LGNs and LUTNs

Deep Differentiable Logic Gate Networks (LGNs) and Lookup Table Networks (LUTNs) are demonstrated to be suitable for the automatic classification of electrocardiograms (ECGs) using the inter-patient paradigm. The methods are benchmarked using the MIT-BIH arrhythmia data set, achieving up to 94.28% accuracy and a $jκ$ index of 0.683 on a four-class classification problem. Our models use between 2.89k and 6.17k FLOPs, including preprocessing and readout, which is three to six orders of magnitude less compared to SOTA methods. A novel preprocessing method is utilized that attains superior performance compared to existing methods for both the mixed-patient and inter-patient paradigms. In addition, a novel method for training the Lookup Tables (LUTs) in LUTNs is devised that uses the Boolean equation of a multiplexer (MUX). Additionally, rate coding was utilized for the first time in these LGNs and LUTNs, enhancing the performance of LGNs. Furthermore, it is the first time that LGNs and LUTNs have been benchmarked on the MIT-BIH arrhythmia dataset using the inter-patient paradigm. Using an Artix 7 FPGA, between 2000 and 2990 LUTs were needed, and between 5 to 7 mW (i.e. 50 pJ to 70 pJ per inference) was estimated for running these models. The performance in terms of both accuracy and $jκ$-index is significantly higher compared to previous LGN results. These positive results suggest that one can utilize LGNs and LUTNs for the detection of arrhythmias at extremely low power and high speeds in heart implants or wearable devices, even for patients not included in the training set.

Enhancing Imbalanced Electrocardiogram Classification: A Novel Approach Integrating Data Augmentation through Wavelet Transform and Interclass Fusion

Imbalanced electrocardiogram (ECG) data hampers the efficacy and resilience of algorithms in the automated processing and interpretation of cardiovascular diagnostic information, which in turn impedes deep learning-based ECG classification. Notably, certain cardiac conditions that are infrequently encountered are disproportionately underrepresented in these datasets. Although algorithmic generation and oversampling of specific ECG signal types can mitigate class skew, there is a lack of consensus regarding the effectiveness of such techniques in ECG classification. Furthermore, the methodologies and scenarios of ECG acquisition introduce noise, further complicating the processing of ECG data. This paper presents a significantly enhanced ECG classifier that simultaneously addresses both class imbalance and noise-related challenges in ECG analysis, as observed in the CPSC 2018 dataset. Specifically, we propose the application of feature fusion based on the wavelet transform, with a focus on wavelet transform-based interclass fusion, to generate the training feature library and the test set feature library. Subsequently, the original training and test data are amalgamated with their respective feature databases, resulting in more balanced training and test datasets. Employing this approach, our ECG model achieves recognition accuracies of up to 99%, 98%, 97%, 98%, 96%, 92%, and 93% for Normal, AF, I-AVB, LBBB, RBBB, PAC, PVC, STD, and STE, respectively. Furthermore, the average recognition accuracy for these categories ranges between 92\% and 98\%. Notably, our proposed data fusion methodology surpasses any known algorithms in terms of ECG classification accuracy in the CPSC 2018 dataset.

BEAT-Net: Injecting Biomimetic Spatio-Temporal Priors for Interpretable ECG Classification

Although deep learning has advanced automated electrocardiogram (ECG) diagnosis, prevalent supervised methods typically treat recordings as undifferentiated one-dimensional (1D) signals or two-dimensional (2D) images. This formulation compels models to learn physiological structures implicitly, resulting in data inefficiency and opacity that diverge from medical reasoning. To address these limitations, we propose BEAT-Net, a Biomimetic ECG Analysis with Tokenization framework that reformulates the problem as a language modeling task. Utilizing a QRS tokenization strategy to transform continuous signals into biologically aligned heartbeat sequences, the architecture explicitly decomposes cardiac physiology through specialized encoders that extract local beat morphology while normalizing spatial lead perspectives and modeling temporal rhythm dependencies. Evaluations across three large-scale benchmarks demonstrate that BEAT-Net matches the diagnostic accuracy of dominant convolutional neural network (CNN) architectures while substantially improving robustness. The framework exhibits exceptional data efficiency, recovering fully supervised performance using only 30 to 35 percent of annotated data. Moreover, learned attention mechanisms provide inherent interpretability by spontaneously reproducing clinical heuristics, such as Lead II prioritization for rhythm analysis, without explicit supervision. These findings indicate that integrating biological priors offers a computationally efficient and interpretable alternative to data-intensive large-scale pre-training.

Towards Automated Diagnosis of Inherited Arrhythmias: Combined Arrhythmia Classification Using Lead-Aware Spatial Attention Networks

Arrhythmogenic right ventricular cardiomyopathy (ARVC) and long QT syndrome (LQTS) are inherited arrhythmia syndromes associated with sudden cardiac death. Deep learning shows promise for ECG interpretation, but multi-class inherited arrhythmia classification with clinically grounded interpretability remains underdeveloped. Our objective was to develop and validate a lead-aware deep learning framework for multi-class (ARVC vs LQTS vs control) and binary inherited arrhythmia classification, and to determine optimal strategies for integrating ECG foundation models within arrhythmia screening tools. We assembled a 13-center Canadian cohort (645 patients; 1,344 ECGs). We evaluated four ECG foundation models using three transfer learning approaches: linear probing, fine-tuning, and combined strategies. We developed lead-aware spatial attention networks (LASAN) and assessed integration strategies combining LASAN with foundation models. Performance was compared against the established foundation model baselines. Lead-group masking quantified disease-specific lead dependence. Fine-tuning outperformed linear probing and combined strategies across all foundation models (mean macro-AUROC 0.904 vs 0.825). The best lead-aware integrations achieved near-ceiling performance (HuBERT-ECG hybrid: macro-AUROC 0.990; ARVC vs control AUROC 0.999; LQTS vs control AUROC 0.994). Lead masking demonstrated physiologic plausibility: V1-V3 were most critical for ARVC detection (4.54% AUROC reduction), while lateral leads were preferentially important for LQTS (2.60% drop). Lead-aware architectures achieved state-of-the-art performance for inherited arrhythmia classification, outperforming all existing published models on both binary and multi-class tasks while demonstrating clinically aligned lead dependence. These findings support potential utility for automated ECG screening pending validation.

Continual Quantum Architecture Search with Tensor-Train Encoding: Theory and Applications to Signal Processing

We introduce CL-QAS, a continual quantum architecture search framework that mitigates the challenges of costly amplitude encoding and catastrophic forgetting in variational quantum circuits. The method uses Tensor-Train encoding to efficiently compress high-dimensional stochastic signals into low-rank quantum feature representations. A bi-loop learning strategy separates circuit parameter optimization from architecture exploration, while an Elastic Weight Consolidation regularization ensures stability across sequential tasks. We derive theoretical upper bounds on approximation, generalization, and robustness under quantum noise, demonstrating that CL-QAS achieves controllable expressivity, sample-efficient generalization, and smooth convergence without barren plateaus. Empirical evaluations on electrocardiogram (ECG)-based signal classification and financial time-series forecasting confirm substantial improvements in accuracy, balanced accuracy, F1 score, and reward. CL-QAS maintains strong forward and backward transfer and exhibits bounded degradation under depolarizing and readout noise, highlighting its potential for adaptive, noise-resilient quantum learning on near-term devices.

Unveiling the Heart-Brain Connection: An Analysis of ECG in Cognitive Performance

Understanding the interaction of neural and cardiac systems during cognitive activity is critical to advancing physiological computing. Although EEG has been the gold standard for assessing mental workload, its limited portability restricts its real-world use. Widely available ECG through wearable devices proposes a pragmatic alternative. This research investigates whether ECG signals can reliably reflect cognitive load and serve as proxies for EEG-based indicators. In this work, we present multimodal data acquired from two different paradigms involving working-memory and passive-listening tasks. For each modality, we extracted ECG time-domain HRV metrics and Catch22 descriptors against EEG spectral and Catch22 features, respectively. We propose a cross-modal XGBoost framework to project the ECG features onto EEG-representative cognitive spaces, thereby allowing workload inferences using only ECG. Our results show that ECG-derived projections expressively capture variation in cognitive states and provide good support for accurate classification. Our findings underpin ECG as an interpretable, real-time, wearable solution for everyday cognitive monitoring.