Learning Cardiac Latent Representations in Vectorcardiogram Space

Self-supervised electrocardiogram (ECG) models are often trained on a few seconds of ECG signal and, increasingly, on discretized token sequences. It remains unclear whether these choices sacrifice information needed for rhythm inference and longitudinal consistency in real-world ambulatory recordings. We present a controlled study on the Icentia11k single-lead dataset that varies (i) the input horizon (16 seconds, 1 minute, 5 minutes, and 10 minutes) and (ii) the front-end representation (continuous convolutional patch embeddings vs. fixed vector-quantized tokens), while holding the Transformer backbone and training protocol constant. Representations are assessed by downstream abnormal rhythm detection and by patient-level retrieval that probes cross-session stability. Our results show that increasing temporal context beyond 16-second snapshots yields stronger transfer and higher retrieval accuracy, with the strongest performance achieved by the 5- and 10-minute models, indicating improved capture of slow-varying rhythm dynamics and individual-specific structure. Across all evaluated horizons, continuous patch embeddings outperform discretized tokens, suggesting that quantization can discard clinically relevant waveform detail. These findings motivate ECG foundation models that emphasize extended context and continuous encoders for clinical prediction and similarity-based applications. Our code and pretrained models are publicly available at https://github.com/muha-0/ecg-ssl-representation-learning.

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.

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.