CPR: Causal Physiological Representation Learning for Robust ECG Analysis under Distribution Shifts

Deep learning models for Electrocardiogram (ECG) diagnosis have achieved remarkable accuracy but exhibit fragility against adversarial perturbations, particularly Smooth Adversarial Perturbations (SAP) that mimic biological morphology. Existing defenses face a critical dilemma: Adversarial Training (AT) provides robustness but incurs a prohibitive computational burden, while certified methods like Randomized Smoothing (RS) introduce significant inference latency, rendering them impractical for real-time clinical monitoring. We posit that this vulnerability stems from the models' reliance on non-robust spurious correlations rather than invariant pathological features. To address this, we propose Causal Physiological Representation Learning (CPR). Unlike standard denoising approaches that operate without semantic constraints, CPR incorporates a Physiological Structural Prior within a causal disentanglement framework. By modeling ECG generation via a Structural Causal Model (SCM), CPR enforces a structural intervention that strictly separates invariant pathological morphology (P-QRS-T complex) from non-causal artifacts. Empirical results on PTB-XL demonstrate that CPR significantly outperforms standard clinical preprocessing methods. Specifically, under SAP attacks, CPR achieves an F1 score of 0.632, surpassing Median Smoothing (0.541 F1) by 9.1%. Crucially, CPR matches the certified robustness of Randomized Smoothing while maintaining single-pass inference efficiency, offering a superior trade-off between robustness, efficiency, and clinical interpretability.

Lightweight Deep Autoencoder for ECG Denoising with Morphology Preservation and Near Real-Time Hardware Deployment

Electrocardiogram (ECG) signals are often degraded by various noise sources such as baseline wander, motion artifacts, and electromyographic interference, posing a major challenge in clinical settings. This paper presents a lightweight deep learning-based denoising framework, forming a compact autoencoder architecture. The model was trained under severe noise conditions (-5 dB signal-to-noise ratio (SNR)) using a rigorously partitioned dataset to ensure no data leakage and robust generalization. Extensive evaluations were conducted across seven noise configurations and three SNR levels (-5 dB, 0 dB, and +5 dB), showing consistent denoising performance with minimal morphological distortion, critical for maintaining diagnostic integrity. In particular, tests on clinically vital rhythms such as ventricular tachycardia (VT) and ventricular fibrillation (VF) confirm that the proposed model effectively suppresses noise without altering arrhythmic features essential for diagnosis. Visual and quantitative assessments, including SNR improvement, RMSE, and correlation metrics, validate the model's efficacy in preserving waveform fidelity. To demonstrate real-world applicability, the model was deployed on a Raspberry Pi 4 using TensorFlow Lite with float16 precision. Inference latency was measured at just 1.41 seconds per 14-second ECG segment, indicating feasibility for near-real-time use in edge devices. Overall, this study introduces a lightweight, hardware-validated, and morphologically reliable ECG denoising solution suitable for integration into portable or wearable healthcare systems.

Versatile and Risk-Sensitive Cardiac Diagnosis via Graph-Based ECG Signal Representation

Despite the rapid advancements of electrocardiogram (ECG) signal diagnosis and analysis methods through deep learning, two major hurdles still limit their clinical adoption: the lack of versatility in processing ECG signals with diverse configurations, and the inadequate detection of risk signals due to sample imbalances. Addressing these challenges, we introduce VersAtile and Risk-Sensitive cardiac diagnosis (VARS), an innovative approach that employs a graph-based representation to uniformly model heterogeneous ECG signals. VARS stands out by transforming ECG signals into versatile graph structures that capture critical diagnostic features, irrespective of signal diversity in the lead count, sampling frequency, and duration. This graph-centric formulation also enhances diagnostic sensitivity, enabling precise localization and identification of abnormal ECG patterns that often elude standard analysis methods. To facilitate representation transformation, our approach integrates denoising reconstruction with contrastive learning to preserve raw ECG information while highlighting pathognomonic patterns. We rigorously evaluate the efficacy of VARS on three distinct ECG datasets, encompassing a range of structural variations. The results demonstrate that VARS not only consistently surpasses existing state-of-the-art models across all these datasets but also exhibits substantial improvement in identifying risk signals. Additionally, VARS offers interpretability by pinpointing the exact waveforms that lead to specific model outputs, thereby assisting clinicians in making informed decisions. These findings suggest that our VARS will likely emerge as an invaluable tool for comprehensive cardiac health assessment.

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.

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.

Versatile Cardiovascular Signal Generation with a Unified Diffusion Transformer

Cardiovascular signals such as photoplethysmography (PPG), electrocardiography (ECG), and blood pressure (BP) are inherently correlated and complementary, together reflecting the health of cardiovascular system. However, their joint utilization in real-time monitoring is severely limited by diverse acquisition challenges from noisy wearable recordings to burdened invasive procedures. Here we propose UniCardio, a multi-modal diffusion transformer that reconstructs low-quality signals and synthesizes unrecorded signals in a unified generative framework. Its key innovations include a specialized model architecture to manage the signal modalities involved in generation tasks and a continual learning paradigm to incorporate varying modality combinations. By exploiting the complementary nature of cardiovascular signals, UniCardio clearly outperforms recent task-specific baselines in signal denoising, imputation, and translation. The generated signals match the performance of ground-truth signals in detecting abnormal health conditions and estimating vital signs, even in unseen domains, while ensuring interpretability for human experts. These advantages position UniCardio as a promising avenue for advancing AI-assisted healthcare.

Wavelet Integrated Convolutional Neural Network for ECG Signal Denoising

Wearable electrocardiogram (ECG) measurement using dry electrodes has a problem with high-intensity noise distortion. Hence, a robust noise reduction method is required. However, overlapping frequency bands of ECG and noise make noise reduction difficult. Hence, it is necessary to provide a mechanism that changes the characteristics of the noise based on its intensity and type. This study proposes a convolutional neural network (CNN) model with an additional wavelet transform layer that extracts the specific frequency features in a clean ECG. Testing confirms that the proposed method effectively predicts accurate ECG behavior with reduced noise by accounting for all frequency domains. In an experiment, noisy signals in the signal-to-noise ratio (SNR) range of -10-10 are evaluated, demonstrating that the efficiency of the proposed method is higher when the SNR is small.

MECG-E: Mamba-based ECG Enhancer for Baseline Wander Removal

Electrocardiogram (ECG) is an important non-invasive method for diagnosing cardiovascular disease. However, ECG signals are susceptible to noise contamination, such as electrical interference or signal wandering, which reduces diagnostic accuracy. Various ECG denoising methods have been proposed, but most existing methods yield suboptimal performance under very noisy conditions or require several steps during inference, leading to latency during online processing. In this paper, we propose a novel ECG denoising model, namely Mamba-based ECG Enhancer (MECG-E), which leverages the Mamba architecture known for its fast inference and outstanding nonlinear mapping capabilities. Experimental results indicate that MECG-E surpasses several well-known existing models across multiple metrics under different noise conditions. Additionally, MECG-E requires less inference time than state-of-the-art diffusion-based ECG denoisers, demonstrating the model's functionality and efficiency.

MSEMG: Surface Electromyography Denoising with a Mamba-based Efficient Network

Surface electromyography (sEMG) recordings can be contaminated by electrocardiogram (ECG) signals when the monitored muscle is closed to the heart. Traditional signal-processing-based approaches, such as high-pass filtering and template subtraction, have been used to remove ECG interference but are often limited in their effectiveness. Recently, neural-network-based methods have shown greater promise for sEMG denoising, but they still struggle to balance both efficiency and effectiveness. In this study, we introduce MSEMG, a novel system that integrates the Mamba State Space Model with a convolutional neural network to serve as a lightweight sEMG denoising model. We evaluated MSEMG using sEMG data from the Non-Invasive Adaptive Prosthetics database and ECG signals from the MIT-BIH Normal Sinus Rhythm Database. The results show that MSEMG outperforms existing methods, generating higher-quality sEMG signals with fewer parameters. The source code for MSEMG is available at https://github.com/tonyliu0910/MSEMG.

ECG Signal Denoising Using Multi-scale Patch Embedding and Transformers

Cardiovascular disease is a major life-threatening condition that is commonly monitored using electrocardiogram (ECG) signals. However, these signals are often contaminated by various types of noise at different intensities, significantly interfering with downstream tasks. Therefore, denoising ECG signals and increasing the signal-to-noise ratio is crucial for cardiovascular monitoring. In this paper, we propose a deep learning method that combines a one-dimensional convolutional layer with transformer architecture for denoising ECG signals. The convolutional layer processes the ECG signal by various kernel/patch sizes and generates an embedding called multi-scale patch embedding. The embedding then is used as the input of a transformer network and enhances the capability of the transformer for denoising the ECG signal.