Deep neural networks have become increasingly popular for analyzing ECG data because of their ability to accurately identify cardiac conditions and hidden clinical factors. However, the lack of transparency due to the black box nature of these models is a common concern. To address this issue, explainable AI (XAI) methods can be employed. In this study, we present a comprehensive analysis of post-hoc XAI methods, investigating the local (attributions per sample) and global (based on domain expert concepts) perspectives. We have established a set of sanity checks to identify sensible attribution methods, and we provide quantitative evidence in accordance with expert rules. This dataset-wide analysis goes beyond anecdotal evidence by aggregating data across patient subgroups. Furthermore, we demonstrate how these XAI techniques can be utilized for knowledge discovery, such as identifying subtypes of myocardial infarction. We believe that these proposed methods can serve as building blocks for a complementary assessment of the internal validity during a certification process, as well as for knowledge discovery in the field of ECG analysis.

In addition to the impressive predictive power of machine learning (ML) models, more recently, explanation methods have emerged that enable an interpretation of complex non-linear learning models such as deep neural networks. Gaining a better understanding is especially important e.g. for safety-critical ML applications or medical diagnostics etc. While such Explainable AI (XAI) techniques have reached significant popularity for classifiers, so far little attention has been devoted to XAI for regression models (XAIR). In this review, we clarify the fundamental conceptual differences of XAI for regression and classification tasks, establish novel theoretical insights and analysis for XAIR, provide demonstrations of XAIR on genuine practical regression problems, and finally discuss the challenges remaining for the field.