The electrocardiogram (ECG) is a key diagnostic tool in cardiovascular health. Single-lead ECG recording is integrated into both clinical-grade and consumer wearables. While self-supervised pretraining of foundation models on unlabeled ECGs improves diagnostic performance, existing approaches do not incorporate domain knowledge from clinical metadata. We introduce a novel contrastive learning approach that utilizes an established clinical risk score to adaptively weight negative pairs: clinically-guided contrastive learning. It aligns the similarities of ECG embeddings with clinically meaningful differences between subjects, with an explicit mechanism to handle missing metadata. On 12-lead ECGs from 161K patients in the MIMIC-IV dataset, we pretrain single-lead ECG foundation models at three scales, collectively called CLEF, using only routinely collected metadata without requiring per-sample ECG annotations. We evaluate CLEF on 18 clinical classification and regression tasks across 7 held-out datasets, and benchmark against 5 foundation model baselines and 3 self-supervised algorithms. When pretrained on 12-lead ECG data and tested on lead-I data, CLEF outperforms self-supervised foundation model baselines: the medium-sized CLEF achieves average AUROC improvements of at least 2.6% in classification and average reductions in MAEs of at least 3.2% in regression. Comparing with existing self-supervised learning algorithms, CLEF improves the average AUROC by at least 1.8%. Moreover, when pretrained only on lead-I data for classification tasks, CLEF performs comparably to the state-of-the-art ECGFounder, which was trained in a supervised manner. Overall, CLEF enables more accurate and scalable single-lead ECG analysis, advancing remote health monitoring. Code and pretrained CLEF models are available at: github.com/Nokia-Bell-Labs/ecg-foundation-model.

The electrocardiogram (ECG) is an essential and effective tool for diagnosing heart diseases. However, its effectiveness can be compromised by noise or unavailability of one or more leads of the standard 12-lead recordings, resulting in diagnostic errors or uncertainty. To address these challenges, we propose TolerantECG, a foundation model for ECG signals that is robust to noise and capable of functioning with arbitrary subsets of the standard 12-lead ECG. TolerantECG training combines contrastive and self-supervised learning frameworks to jointly learn ECG signal representations alongside their corresponding knowledge-retrieval-based text report descriptions and corrupted or lead-missing signals. Comprehensive benchmarking results demonstrate that TolerantECG consistently ranks as the best or second-best performer across various ECG signal conditions and class levels in the PTB-XL dataset, and achieves the highest performance on the MIT-BIH Arrhythmia Database.

The diagnostic value of electrocardiogram (ECG) lies in its dynamic characteristics, ranging from rhythm fluctuations to subtle waveform deformations that evolve across time and frequency domains. However, supervised ECG models tend to overfit dominant and repetitive patterns, overlooking fine-grained but clinically critical cues, a phenomenon known as Simplicity Bias (SB), where models favor easily learnable signals over subtle but informative ones. In this work, we first empirically demonstrate the presence of SB in ECG analyses and its negative impact on diagnostic performance, while simultaneously discovering that self-supervised learning (SSL) can alleviate it, providing a promising direction for tackling the bias. Following the SSL paradigm, we propose a novel method comprising two key components: 1) Temporal-Frequency aware Filters to capture temporal-frequency features reflecting the dynamic characteristics of ECG signals, and 2) building on this, Multi-Grained Prototype Reconstruction for coarse and fine representation learning across dual domains, further mitigating SB. To advance SSL in ECG analyses, we curate a large-scale multi-site ECG dataset with 1.53 million recordings from over 300 clinical centers. Experiments on three downstream tasks across six ECG datasets demonstrate that our method effectively reduces SB and achieves state-of-the-art performance.

Electrocardiograms (ECGs) play a vital role in monitoring cardiac health and diagnosing heart diseases. However, traditional deep learning approaches for ECG analysis rely heavily on large-scale manual annotations, which are both time-consuming and resource-intensive to obtain. To overcome this limitation, self-supervised learning (SSL) has emerged as a promising alternative, enabling the extraction of robust ECG representations that can be efficiently transferred to various downstream tasks. While previous studies have explored SSL for ECG pretraining and multi-modal ECG-language alignment, they often fail to capture the multi-scale nature of ECG signals. As a result, these methods struggle to learn generalized representations due to their inability to model the hierarchical structure of ECG data. To address this gap, we introduce MELP, a novel Multi-scale ECG-Language Pretraining (MELP) model that fully leverages hierarchical supervision from ECG-text pairs. MELP first pretrains a cardiology-specific language model to enhance its understanding of clinical text. It then applies three levels of cross-modal supervision-at the token, beat, and rhythm levels-to align ECG signals with textual reports, capturing structured information across different time scales. We evaluate MELP on three public ECG datasets across multiple tasks, including zero-shot ECG classification, linear probing, and transfer learning. Experimental results demonstrate that MELP outperforms existing SSL methods, underscoring its effectiveness and adaptability across diverse clinical applications. Our code is available at https://github.com/HKU-MedAI/MELP.

Electrocardiograms (ECGs) are essential for monitoring cardiac health, allowing clinicians to analyze heart rate variability (HRV), detect abnormal rhythms, and diagnose cardiovascular diseases. However, ECG signals, especially those from wearable devices, are often affected by noise artifacts caused by motion, muscle activity, or device-related interference. These artifacts distort R-peaks and the characteristic QRS complex, making HRV analysis unreliable and increasing the risk of misdiagnosis. Despite this, the few existing studies on ECG noise detection have primarily focused on a single dataset, limiting the understanding of how well noise detection models generalize across different datasets. In this paper, we investigate the generalizability of noise detection in ECG using a novel HRV-based approach through cross-dataset experiments on four datasets. Our results show that machine learning achieves an average accuracy of over 90\% and an AUPRC of more than 0.9. These findings suggest that regardless of the ECG data source or the type of noise, the proposed method maintains high accuracy even on unseen datasets, demonstrating the feasibility of generalizability.

Electrocardiogram (ECG) is essential for the clinical diagnosis of arrhythmias and other heart diseases, but deep learning methods based on ECG often face limitations due to the need for high-quality annotations. Although previous ECG self-supervised learning (eSSL) methods have made significant progress in representation learning from unannotated ECG data, they typically treat ECG signals as ordinary time-series data, segmenting the signals using fixed-size and fixed-step time windows, which often ignore the form and rhythm characteristics and latent semantic relationships in ECG signals. In this work, we introduce a novel perspective on ECG signals, treating heartbeats as words and rhythms as sentences. Based on this perspective, we first designed the QRS-Tokenizer, which generates semantically meaningful ECG sentences from the raw ECG signals. Building on these, we then propose HeartLang, a novel self-supervised learning framework for ECG language processing, learning general representations at form and rhythm levels. Additionally, we construct the largest heartbeat-based ECG vocabulary to date, which will further advance the development of ECG language processing. We evaluated HeartLang across six public ECG datasets, where it demonstrated robust competitiveness against other eSSL methods. Our data and code are publicly available at https://github.com/PKUDigitalHealth/HeartLang. Electrocardiogram (ECG) is a common type of clinical data used to monitor cardiac activity, and is frequently employed in diagnosing cardiac diseases or conditions impairing myocardial function (Hong et al., 2020; Liu et al., 2021). A primary limitation of using supervised deep learning methods for ECG signal analysis is their dependency on largescale, expert-reviewed, annotated high-quality data.

This study introduces a deep learning model based on the U-net architecture to reconstruct missing leads in electrocardiograms (ECGs). Using publicly available datasets, the model was trained to regenerate 12-lead ECG data from reduced lead configurations, demonstrating high accuracy in lead reconstruction. The results highlight the ability of the model to quantify the information content of each ECG lead and their inter-lead correlations. This has significant implications for optimizing lead selection in diagnostic scenarios, particularly in settings where full 12-lead ECGs are impractical. Additionally, the study provides insights into the physiological underpinnings of ECG signals and their propagation. The findings pave the way for advancements in telemedicine, portable ECG devices, and personalized cardiac diagnostics by reducing redundancy and enhancing signal interpretation.

Electrocardiogram (ECG) is a reliable tool for medical professionals to detect and diagnose abnormal heart waves that may cause cardiovascular diseases. This paper proposes a methodology to create a new high-quality heartbeat dataset from all 48 of the MIT-BIH recordings. The proposed approach computes an optimal heartbeat size, by eliminating outliers and calculating the mean value over 10-second windows. This results in independent QRS-centered heartbeats avoiding the mixing of successive heartbeats problem. The quality of the newly constructed dataset has been evaluated and compared with existing datasets. To this end, we built and trained a PyTorch 1-D Resnet architecture model that achieved 99.24\% accuracy with a 5.7\% improvement compared to other methods. Additionally, downsampling the dataset has improved the model's execution time by 33\% and reduced 3x memory usage.

We consider robustness to distribution shifts in the context of diagnostic models in healthcare, where the prediction target $Y$, e.g., the presence of a disease, is causally upstream of the observations $X$, e.g., a biomarker. Distribution shifts may occur, for instance, when the training data is collected in a domain with patients having particular demographic characteristics while the model is deployed on patients from a different demographic group. In the domain of applied ML for health, it is common to predict $Y$ from $X$ without considering further information about the patient. However, beyond the direct influence of the disease $Y$ on biomarker $X$, a predictive model may learn to exploit confounding dependencies (or shortcuts) between $X$ and $Y$ that are unstable under certain distribution shifts. In this work, we highlight a data generating mechanism common to healthcare settings and discuss how recent theoretical results from the causality literature can be applied to build robust predictive models. We theoretically show why ignoring covariates as well as common invariant learning approaches will in general not yield robust predictors in the studied setting, while including certain covariates into the prediction model will. In an extensive simulation study, we showcase the robustness (or lack thereof) of different predictors under various data generating processes. Lastly, we analyze the performance of the different approaches using the PTB-XL dataset, a public dataset of annotated ECG recordings.

Atrial fibrillation (AF) is a common atrial arrhythmia that impairs quality of life and causes embolic stroke, heart failure and other complications. Recent advancements in machine learning (ML) and deep learning (DL) have shown potential for enhancing diagnostic accuracy. It is essential for DL models to be robust and generalizable across variations in ethnicity, age, sex, and other factors. Although a number of ECG database have been made available to the research community, none 1 includes a Japanese population sample. Saitama Heart Database Atrial Fibrillation (SHDB-AF) is a novel open-sourced Holter ECG database from Japan, containing data from 100 unique patients with paroxysmal AF. Each record in SHDB-AF is 24 hours long and sampled at 200 Hz, totaling 24 million seconds of ECG data.