EVL-ECG: Efficient ECG Interpretation With Multi-Aspect Heterogeneous Knowledge Distillation

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.

Electrocardiogram (ECG) interpretation is essential for diagnosing a wide range of cardiac abnormalities. While deep learning has shown strong potential for automating ECG classification, many existing models rely on large, computationally intensive architectures that hinder practical deployment. In this paper, we present an empirical study of convolutional neural network (CNN) architectures, exploring tradeoffs between diagnostic accuracy and computational efficiency. We benchmark two established baselines: AttiaNet, a compact model composed of sequential temporal and spatial blocks, and DeepResidualCNN, the winning architecture of the 2021 PhysioNet/Computing in Cardiology Challenge. Building on these, we propose three lightweight models: (i) ParallelCNN, which employs dual temporal and spatial branches for parallel pattern extraction; (ii) ParallelCNNew, a variant with symmetric weight initialization for balanced feature learning; and (iii) SimpleNet, a streamlined architecture that jointly processes temporal and spatial dimensions. Our experiments span three publicly available 12-lead ECG datasets from Germany, China, and the United States, covering binary, multiclass, and multilabel classification tasks across diverse patient populations. We further evaluate the impact of integrating low-cost demographic metadata (age and sex) to improve performance with minimal overhead. To ensure fair comparison, we introduce a unified Efficiency Score that integrates model size, inference speed, memory usage, and AUC performance. By balancing diagnostic performance and efficiency, our models offer a scalable and viable foundation for next-generation AI systems in cardiovascular care.

ECG-Language Models (ELMs) extend recent advances in Multimodal Large Language Models (MLLMs) to automated ECG interpretation. However, most existing ELMs inherit Vision-Language Model (VLM) design choices and rely on pretrained ECG encoders, introducing substantial architectural and training complexity. Inspired by encoder-free VLMs, we introduce ELF, a family of three encoder-free ELMs that remain competitive with, and often outperform, prior state-of-the-art ELMs across two datasets despite substantially simpler architectures and training pipelines. All code and data are available at github.com/ELM-Research/ECG-Language-Models.