ECG-MoE: Mixture-of-Expert Electrocardiogram Foundation Model

Electrocardiograms (ECG) are electrical recordings of the heart that are critical for diagnosing cardiovascular conditions. ECG language models (ELMs) have recently emerged as a promising framework for ECG classification accompanied by report generation. However, current models cannot forecast future cardiac events despite the immense clinical value for planning earlier intervention. To address this gap, we propose CAMEL, the first ELM that is capable of inference over longer signal durations which enables its forecasting capability. Our key insight is a specialized ECG encoder which enables cross-understanding of ECG signals with text. We train CAMEL using established LLM training procedures, combining LoRA adaptation with a curriculum learning pipeline. Our curriculum includes ECG classification, metrics calculations, and multi-turn conversations to elicit reasoning. CAMEL demonstrates strong zero-shot performance across 6 tasks and 9 datasets, including ECGForecastBench, a new benchmark that we introduce for forecasting arrhythmias. CAMEL is on par with or surpasses ELMs and fully supervised baselines both in- and out-of-distribution, achieving SOTA results on ECGBench (+7.0% absolute average gain) as well as ECGForecastBench (+12.4% over fully supervised models and +21.1% over zero-shot ELMs).

Electrocardiograms (ECGs) are among the most widely available clinical signals and play a central role in cardiovascular diagnosis. While recent foundation models (FMs) have shown promise for learning transferable ECG representations, most existing pretraining approaches treat leads as independent channels and fail to explicitly leverage their strong structural redundancy. We introduce the latent attention masked autoencoder (LAMAE) FM that directly exploits this structure by learning cross-lead connection mechanisms during self-supervised pretraining. Our approach models higher-order interactions across leads through latent attention, enabling permutation-invariant aggregation and adaptive weighting of lead-specific representations. We provide empirical evidence on the Mimic-IV-ECG database that leveraging the cross-lead connection constitutes an effective form of structural supervision, improving representation quality and transferability. Our method shows strong performance in predicting ICD-10 codes, outperforming independent-lead masked modeling and alignment-based baselines.

Electrocardiography (ECG) records the electrical activity of the heart, aiding diagnosis by detecting abnormalities in cardiac function. ECG foundation models have demonstrated promising results, but are limited by a reliance on ECG interpretation reports as their sole supervision. Because interpretation reports only capture the subset of waveform information routinely recognized by clinicians, this constrains representation learning to overlook the broader diagnostic signals present in ECG. We introduce a new ECG foundation model --- MS-ECG-FM --- that is trained through contrastive alignment to multiple distinct clinical note types, including ECG, echocardiography, radiology, and discharge reports. We evaluate MS-ECG-FM on an extended set of ECG detection benchmarks, showing that it comprehensively outperforms existing methods on the full span of conditions that ECG can detect, including in reduced-lead configurations. Different reports improve representations for different diagnostic domains, while multi-source alignment captures their complementary information and produces consistently strong representations across clinically diverse tasks.