Accepted at CISP-BMEI 2025 Abstract--Early and accurate detection of cardiac arrhythmias is vital for timely diagnosis and intervention. We propose a lightweight deep learning model combining 1D Convolutional Neural Networks (CNN), attention mechanisms, and Bidirectional Long Short-T erm Memory (BiLSTM) for classifying arrhythmias from both 12-lead and single-lead ECGs. Evaluated on the CPSC 2018 dataset, the model addresses class imbalance using a class-weighted loss and demonstrates superior accuracy and F1-scores over baseline models. With only 0.945 million parameters, our model is well-suited for real-time deployment in wearable health monitoring systems. The source code is available at https://github.com/infocusp/tiny Cardiovascular diseases (CVDs) remain the leading cause of morbidity and mortality worldwide, accounting for approximately 17.9 million deaths each year according to the World Health Organization (WHO) [1]. Electrocardiography (ECG) is a simple yet effective technique for detecting arrhythmias.

Early detection of heart arrhythmia can prevent severe future complications in cardiac patients. While manual diagnosis still remains the clinical standard, it relies heavily on visual interpretation and is inherently subjective. In recent years, deep learning has emerged as a powerful tool to automate arrhythmia detection, offering improved accuracy, consistency, and efficiency. Several variants of convolutional and recurrent neural network architectures have been widely explored to capture spatial and temporal patterns in physiological signals. However, despite these advancements, current models often struggle to generalize well in real-world scenarios, especially when dealing with small or noisy datasets, which are common challenges in biomedical applications. In this paper, a novel CNN-H-Infinity-LSTM architecture is proposed to identify arrhythmic heart signals from heart sound recordings. This architecture introduces trainable parameters inspired by the H-Infinity filter from control theory, enhancing robustness and generalization. Extensive experimentation on the PhysioNet CinC Challenge 2016 dataset, a public benchmark of heart audio recordings, demonstrates that the proposed model achieves stable convergence and outperforms existing benchmarks, with a test accuracy of 99.42% and an F1 score of 98.85%.

The electrocardiogram (ECG) exemplifies biosignal-based time series with continuous, temporally ordered structure reflecting cardiac physiological and pathophysiological dynamics. Detailed analysis of these dynamics has proven challenging, as conventional methods capture either global trends or local waveform features but rarely their simultaneous interplay at high temporal resolution. To bridge global and local signal analysis, we introduce S4ECG, a novel deep learning architecture leveraging structured state space models for multi-epoch arrhythmia classification. Our joint multi-epoch predictions significantly outperform single-epoch approaches by 1.0-11.6% in macro-AUROC, with atrial fibrillation specificity improving from 0.718-0.979 to 0.967-0.998, demonstrating superior performance in-distribution and enhanced out-of-distribution robustness. Systematic investigation reveals optimal temporal dependency windows spanning 10-20 minutes for peak performance. This work contributes to a paradigm shift toward temporally-aware arrhythmia detection algorithms, opening new possibilities for ECG interpretation, in particular for complex arrhythmias like atrial fibrillation and atrial flutter.

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

--We propose a deep neural architecture that performs uncertainty-aware multi-view classification of arrhythmia from ECG. Our method learns two different views (1D and 2D) of single-lead ECG to capture different types of information. We use a fusion technique to reduce the conflict between the different views caused by noise and artifacts in ECG data, thus incorporating uncertainty to obtain stronger final predictions. Our framework contains the following three modules (1) a time-series module to learn the morphological features from ECG; (2) an image-space learning module to learn the spatiotemporal features; and (3) the uncertainty-aware fusion module to fuse the information from the two different views. Experimental results on two real-world datasets demonstrate that our framework not only improves the performance on arrhythmia classification compared to the state-of-the-art but also shows better robustness to noise and artifacts present in ECG.

Cardiac arrhythmias are a leading cause of life-threatening cardiac events, highlighting the urgent need for accurate and timely detection. Electrocardiography (ECG) remains the clinical gold standard for arrhythmia diagnosis; however, manual interpretation is time-consuming, dependent on clinical expertise, and prone to human error. Although deep learning has advanced automated ECG analysis, many existing models abstract away the signal's intrinsic temporal and morphological features, lack interpretability, and are computationally intensive-hindering their deployment on resource-constrained platforms. In this work, we propose two novel lightweight 1D convolutional neural networks, ArrhythmiNet V1 and V2, optimized for efficient, real-time arrhythmia classification on edge devices. Inspired by MobileNet's depthwise separable convolutional design, these models maintain memory footprints of just 302.18 KB and 157.76 KB, respectively, while achieving classification accuracies of 0.99 (V1) and 0.98 (V2) on the MIT-BIH Arrhythmia Dataset across five classes: Normal Sinus Rhythm, Left Bundle Branch Block, Right Bundle Branch Block, Atrial Premature Contraction, and Premature Ventricular Contraction. In order to ensure clinical transparency and relevance, we integrate Shapley Additive Explanations and Gradient-weighted Class Activation Mapping, enabling both local and global interpretability. These techniques highlight physiologically meaningful patterns such as the QRS complex and T-wave that contribute to the model's predictions. We also discuss performance-efficiency trade-offs and address current limitations related to dataset diversity and generalizability. Overall, our findings demonstrate the feasibility of combining interpretability, predictive accuracy, and computational efficiency in practical, wearable, and embedded ECG monitoring systems.

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.

In Romania, cardiovascular problems are the leading cause of death, accounting for nearly one-third of annual fatalities. The severity of this situation calls for innovative diagnosis method for cardiovascular diseases. This article aims to explore efficient, light-weight and rapid methods for arrhythmia diagnosis, in resource-constrained healthcare settings. Due to the lack of Romanian public medical data, we trained our systems using international public datasets, having in mind that the ECG signals are the same regardless the patients' nationality. Within this purpose, we combined multiple datasets, usually used in the field of arrhythmias classification: PTB-XL electrocardiography dataset , PTB Diagnostic ECG Database, China 12-Lead ECG Challenge Database, Georgia 12-Lead ECG Challenge Database, and St. Petersburg INCART 12-lead Arrhythmia Database. For the input data, we employed ECG signal processing methods, specifically a variant of the Pan-Tompkins algorithm, useful in arrhythmia classification because it provides a robust and efficient method for detecting QRS complexes in ECG signals. Additionally, we used machine learning techniques, widely used for the task of classification, including convolutional neural networks (1D CNNs, 2D CNNs, ResNet) and Vision Transformers (ViTs). The systems were evaluated in terms of accuracy and F1 score. We annalysed our dataset from two perspectives. First, we fed the systems with the ECG signals and the GRU-based 1D CNN model achieved the highest accuracy of 93.4% among all the tested architectures. Secondly, we transformed ECG signals into images and the CNN2D model achieved an accuracy of 92.16%.

Continual Learning (CL) methods aim to learn from a sequence of tasks while avoiding the challenge of forgetting previous knowledge. We present DREAM-CL, a novel CL method for ECG arrhythmia detection that introduces dynamic prototype rehearsal memory. DREAM-CL selects representative prototypes by clustering data based on learning behavior during each training session. Within each cluster, we apply a smooth sorting operation that ranks samples by training difficulty, compressing extreme values and removing outliers. The more challenging samples are then chosen as prototypes for the rehearsal memory, ensuring effective knowledge retention across sessions. We evaluate our method on time-incremental, class-incremental, and lead-incremental scenarios using two widely used ECG arrhythmia datasets, Chapman and PTB-XL. The results demonstrate that DREAM-CL outperforms the state-of-the-art in CL for ECG arrhythmia detection. Detailed ablation and sensitivity studies are performed to validate the different design choices of our method.

The rapid advancements in Artificial Intelligence, specifically Machine Learning (ML) and Deep Learning (DL), have opened new prospects in medical sciences for improved diagnosis, prognosis, and treatment of severe health conditions. This paper focuses on the development of an ML model with high predictive accuracy to classify arrhythmic electrocardiogram (ECG) signals. The ECG signals datasets utilized in this study were sourced from the PhysioNet and MIT-BIH databases. The research commenced with binary classification, where an optimized Bidirectional Long Short-Term Memory (Bi-LSTM) model yielded excellent results in differentiating normal and atrial fibrillation signals. A pivotal aspect of this research was a survey among medical professionals, which not only validated the practicality of AI-based ECG classifiers but also identified areas for improvement, including accuracy and the inclusion of more arrhythmia types. These insights drove the development of an advanced Convolutional Neural Network (CNN) system capable of classifying five different types of ECG signals with better accuracy and precision. The CNN model's robust performance was ensured through rigorous stratified 5-fold cross validation. A web portal was also developed to demonstrate real-world utility, offering access to the trained model for real-time classification. This study highlights the potential applications of such models in remote health monitoring, predictive healthcare, assistive diagnostic tools, and simulated environments for educational training and interdisciplinary collaboration between data scientists and medical personnel.