HEART: A High-Efficiency Adaptive Real-Time Telemonitoring Framework for Secure Electrocardiogram Signal Transmission Using Chaotic Encryption

A shared electrocardiogram (ECG) is itself a biometric fingerprint that can re-identify a patient and reveal personal information. Recent ECG anonymizers transform the signal before sharing to reduce privacy leakage. However, existing methods still face a privacy--utility trade-off, in which preserving privacy often compromises utility while preserving utility reveals personal information. We propose \emph{REAN} (\emph{RE}construction-aware ECG \emph{AN}onymizer), a raw ECG signal anonymizer, to address this privacy--utility trade-off. REAN reconstructs the signal using a 1-D U-Net trained with losses from frozen privacy and utility classifiers to reduce privacy leakage while preserving utility. The privacy and utility gradients are near-orthogonal ($\approx$93.8$^\circ$), so reducing privacy leakage leaves utility almost unchanged. On four public PhysioNet databases, REAN achieves the strongest privacy--utility balance among raw ECG signal baselines. It drives re-identification to chance (0.96$\to$0.00), keeps arrhythmia macro-AUROC at the clean level (Clean 0.9982 vs.\ REAN 0.9991), and maintains re-identification protection under unseen privacy-classifier architectures.

Electrocardiogram (ECG) biometrics have emerged as a promising modality for continuous, liveness-aware authentication in wearable systems. However, many prior studies report overly optimistic results due to data leakage (e.g., random splits within the same session). To address this issue, we introduce ECG-biometrics-bench, a modular, reproducible benchmarking framework that standardizes preprocessing, segmentation, and evaluation across seven widely used public ECG datasets spanning clinical, ambulatory, and large-scale cohort settings. The framework supports both closed-set and open-set (i.e., subject-disjoint generalization in this work) evaluation, as well as progressively realistic protocols including cross-session and long-term temporal separation. To facilitate reproducible research in the community, the ECG-biometrics-bench repository will be made publicly accessible on GitHub upon the acceptance of this manuscript. Through a comprehensive multi-dataset analysis, we expose the Random Split Fallacy, demonstrating that intra-session evaluation protocols artificially inflate performance while masking severe degradation caused by temporal drift and unseen identities. Furthermore, by evaluating multiple architectures, including DeepECG, ResNet1D, and CNN-LSTM, we show that these failures are not model-specific but are likely inherent to current supervised feature-learning paradigms. Finally, we demonstrate that performance degradation due to temporal aging can be partially mitigated through a heavy enrollment, lightweight authentication strategy based on dynamic multi-session template fusion. These findings establish a more realistic baseline for ECG biometrics and highlight critical challenges that must be addressed for reliable real-world deployment.

Electrocardiograms (ECGs) are widely used non-invasive measurements of cardiac activity and play a central role in clinical diagnosis. Recent multimodal approaches align ECG signals with clinical reports to incorporate diagnostic semantics, but clinical reports often fail to preserve the rich physiological structure of ECG waveforms, particularly across multiple levels of abstraction ranging from coarse diagnostic categories to fine-grained morphology. To address this limitation, we formulate ECG representation learning from an information-theoretic perspective and derive a tractable objective that jointly preserves signal structure and integrates clinical semantics. Based on this principle, we propose \textbf{MERIT} (Multimodal ECG Representation via Information Theory), a dual-branch pretraining framework combining masked ECG modeling with ECG--text contrastive alignment. Extensive experiments on PTB-XL and additional benchmarks demonstrate consistent improvements over prior methods, including gains exceeding $3$ F1 on PTB-XL All and $5$ F1 on SubClass classification. In zero-shot evaluation, MERIT further improves performance by up to $+2.66\%$ AUC and $+2.11\%$ F1 on PTB-XL SubClass, while also demonstrating robustness under multiple distribution-shift settings. Moreover, leveraging the learned ECG representations for ECG-conditioned clinical text generation with large language models improves text quality across several metrics, including ROUGE and METEOR. Together, these results demonstrate that MERIT learns more informative and clinically meaningful ECG representations, particularly for fine-grained clinical applications.