Organizations: Xidian University, China · Department of Computer Science, Tianjin University of Technology, China · DCST, BNRist, RIIT, Institute of Internet Industry, Tsinghua University, China
In multi-source ECG deployment, models may need to incorporate new data sources when earlier raw ECGs cannot be retained or replayed. Freezing a pretrained backbone and assigning each source an isolated classifier prevents parameter interference, but deployment still requires selecting an expert when source metadata are unavailable. We study this distinction through IRFE-ECG, an incremental expert bank built on frozen 1024-dimensional ECGFounder features. Each arriving domain adds a balanced-softmax linear expert, while a lightweight router is fitted only on retained training features and domain labels from sources observed so far. A validation-calibrated margin rule fuses the two most likely experts instead of committing to a single routed expert. On CPSC, PTB-XL, Georgia, and Chapman-Shaoxing, source-aware expert selection reaches 0.7915±0.0036 Macro-F1 and a matched offline independent-head reference reaches 0.7885±0.0009, supporting strong source-aware expert retention. Without source IDs, an MLP router reaches 0.7756±0.0027 and top-2 margin fusion reaches 0.7782±0.0022. The top-2 gain over hard MLP routing is small (+0.0026), with a 95% confidence interval from paired bootstrap that includes zero. Across three domain orders, the top-2-to-oracle gap remains 0.0111--0.0133, identifying autonomous source inference as the main remaining bottleneck. No raw ECGs are replayed, but frozen training features are retained for router updates; the method is therefore not memory-free.Code is available at https://github.com/yufanlu221/IRFE-ECG.
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.
Ahmed Sameh, Ramzi Al-Sharawi, Yogatheesan Varatharajah
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.
Electrocardiogram (ECG) foundation models pretrained on typical diagnostic 10-second ECG segments, have demonstrated strong transferability across a range of clinical applications. However, many real-world applications produce recordings that are typically longer, and are varied in duration during inference time. These 10-second models have no built-in way to combine information across time. Extending them to longer horizons introduces two challenges: structural incompatibilities arising from input-length disparities, and semantic challenges that limit meaningful temporal aggregation. We propose a parameter-efficient framework that extends pretrained ECG foundation models to longer and variable-length ECGs without retraining the backbone. Guided by a frozen pretrained 10-second model, we introduce a lightweight plug-in module that extends the model in two complementary ways: (i) structurally compatible long-sequence processing and (ii) semantically informed temporal modeling. Experiments on multiple long-horizon ECG tasks, datasets, and foundation model backbones demonstrate that our method enables robust long-horizon extension from pretrained snapshot models, consistently outperforming sliding-window and pooling-based baselines with strong parameter efficiency.