Organizations: Department of Computer Engineering, University of Kurdistan, Sanandaj, Iran · Department of Mathematics and Operational Research, University of Mons, Mons, Belgium
Abstract
Electrocardiogram (ECG) arrhythmia classification remains challenging due to signal variability, noise, limited labeled data, and the difficulty in achieving both accuracy and efficiency in models. While self-supervised learning reduces label dependency, most methods target either global contextual features or local morphological patterns, but rarely implement hierarchical multi-scale feature extraction. ECG signals require architectures that simultaneously capture fine-grained beat-level morphology and broader rhythm-level dependencies with computational efficiency. To overcome this limitation, this paper proposes the Electrocardiogram Neighborhood Attention Transformer (ECG-NAT), a novel self-supervised learning approach tailored for multi-lead ECG classification. Our two-stage approach begins with generative pretraining, using a masked autoencoder to reconstruct partially masked ECG signals across multiple diverse datasets, enabling the model to learn robust, domain-invariant representations from unlabeled data. This is followed by discriminative fine-tuning with a dual-loss function that combines supervised contrastive and cross-entropy losses, aligning representation learning with label prediction. The hierarchical attention mechanism efficiently captures multi-scale temporal features from localized beat morphology to broader rhythm patterns at low computational cost. ECG-NAT achieves robust performance on benchmark datasets, with 88.1% accuracy using only 1% labeled data, demonstrating strong efficacy in low-resource settings. The framework combines superior classification performance with computational efficiency, making it practical for real-time ECG diagnosis. The code will be made available upon acceptance at: https://github.com/Mahsagazeran/ECG-NAT.
While Deep Learning (DL) enhances automated electrocardiogram (ECG) analysis, clinical deployment is hindered by class imbalance and the generalization gap. This paper presents HeartBeatAI, a deep learning framework combining domain generalization, multi-scale feature aggregation, and clinical explainability for robust 12-lead ECG classification. Moving beyond image-based paradigms, HeartBeatAI integrates a Squeeze-and-Excitation (SE) ResNet to isolate diagnostic leads alongside a Multi-Layer Concentration Pipeline to capture macro-rhythm and micro-morphological anomalies. To mitigate domain shift, the framework employs MixStyle regularization and Label Smoothing. Rigorous benchmarking across four large-scale datasets using intra-source and Leave-One-Domain-Out (LODO) protocols demonstrates high performance (98% Macro F1-score) under intra-source conditions. However, LODO evaluations reveal significant degradation in detecting rare anomalies, highlighting a persistent challenge in cross-institutional deployment.
Data analysis in the medical domain often encounters scenarios involving a limited target dataset and a large, unannotated dataset with a general distribution. Under such circumstances, self-supervised learning (SSL) methods are highly effective for utilizing large datasets, making them a popular choice for electrocardiogram (ECG) analysis. This work presents the Event Reconstruction Joint-Embedding Predictive Architecture (ER-JEPA), a lightweight SSL framework for multivariate time series, whose name and two-fold hierarchical structure are inspired by the diagnostic approach of cardiologists. At its core, ER-JEPA features: (1) a two-stage structure that constructs representations for each time interval and subsequently processes these representations as a univariate time series, (2) the hierarchical integration of two Joint-Embedding Predictive Architectures (JEPAs), and (3) a Vision Transformer (ViT) backbone. The structural concatenation of two JEPAs categorizes the model as a Hierarchical JEPA (H-JEPA), designed to encode multiple levels of abstract representations for enhanced prediction on complex tasks. This study reports a successful application of H-JEPA to 12-lead ECG data as a multivariate time series, alongside an analysis of the sensitivity of hierarchical representation during the pretraining stage. Pretrained on approximately 180,000 10-second recordings, the model achieves state-of-the-art downstream performance on the ST-MEM benchmark, with rapid computation and minimal resource usage.
Deploying deep learning models for automated electrocardiogram classification on resource-constrained wearable devices remains challenging due to high computational costs. To address this, we propose LSTrans, a lightweight hybrid model designed for efficient and sensitive ECG analysis. LSTrans introduces a specialized 1D convolutional backbone with an interleaved layer architecture to capture both macroscopic rhythmic trends and microscopic morphological variations. This backbone is cascaded with a Transformer encoder to model long-range temporal dependencies, incorporating Low-Rank Adaptation across critical layers to compress the model and reduce the trainable parameter space. We further employ homogeneous and heterogeneous knowledge distillation to transfer diagnostic expertise from high-capacity teacher models to the student. Experimental results on multiple benchmark datasets demonstrate that LSTrans achieves a competitive balance between diagnostic sensitivity and resource efficiency, substantially reducing peak memory footprints and training latency during downstream adaptation. The source code is available for review at https://github.com/zyee00128/LSTrans4BIBM.