Same path, different: a mechanistic comparison of looped and stacked transformer encoders on 12-lead ECG

While scaling laws have established a fundamental framework for foundation models in natural language processing, their applicability to electrocardiogram (ECG) models remains poorly characterized. Indeed, recent studies do not always yield consistent downstream gains as one increases the model size or pre-training dataset size of ECG models, leaving the exact roles of architectural inductive biases, pre-training paradigms, and expected improvements with size largely unanswered. In this work, we systematically investigate neural and loss-to-loss scaling laws within the ECG domain. By pre-training over $120$ models (ranging from $20$K to $200$M parameters) on the large-scale CODE dataset ($2.3$M records), we decouple the effects of model architecture (ResNet vs. Transformer) and pre-training paradigm, namely supervised learning (SL) versus self-supervised learning (SSL). We found that (i) SL models are data-bottlenecked in-distribution, whereas SSL models scale robustly across both model and data sizes; (ii) for out-of-distribution (OOD) generalization, ResNets are $1.3$ to $2.5$ times more parameter-efficient than Transformers, while SSL is up to $16$ times more data-efficient and achieves up to $7.6$ times higher transfer efficiency than SL on unseen clinical tasks; (iii) across the observed scales, ResNet-based models generally achieve the lowest OOD loss, with SSL dominating on unseen clinical tasks and self-supervised Transformers overtaking at very large model sizes. Our results suggest that the path to effective ECG foundation models lies in the strategic alignment of architecture and paradigm rather than brute-force scaling.

Vision Transformers (ViTs) are built by stacking independently parameterized blocks, but it remains unclear how much of this depth requires layer specific transformations and how much can be realized through recurrent computation. We study this question with bViT, a single-block recurrent ViT in which one transformer block is applied repeatedly to process an image. This architecture preserves the iterative structure of a deep ViT while removing layer specific block parameterization, providing a controlled setting for studying recurrence in vision. On ImageNet-1K, a 12-step bViT-B achieves accuracy comparable to standard ViT-B under the same training recipe and computational budget, while using an order of magnitude fewer parameters. We observe that recurrent performance improves with representation width, with wider bViTs recovering much more of the performance of standard ViTs than narrow variants. We interpret this behavior as implicit depth multiplexing, where a shared block expresses multiple step-dependent computations through the evolving hidden state. Beyond ImageNet classification, bViT transfers competitively to downstream tasks and enables parameter-efficient fine-tuning. Mechanistic analyses of activations, attention and step-specific pruning show that the shared block changes its effective behavior across recurrent steps rather than simply repeating the same computation. Our results suggest that a large fraction of ViT depth can be implemented through recurrent reuse, provided that the representation space is sufficiently wide.

Tokenization determines both the physiological content presented to an ECG Transformer and the sequence over which attention operates. We compare eight tokenization strategies across Transformer, Informer, Reformer, and FEDformer on the nine-label CPSC2018 classification task. The input projection and principal backbone capacity are controlled to isolate the effect of token construction. Median-beat and HeartLang tokenization achieve mean macro-AUCs of 0.893 and 0.889 across the four backbones, compared with 0.822 and 0.824 for point-wise and patch-wise tokenization. Pooling the two physiology-aware representations yields an 8.2% relative improvement in macro-AUC. They also reduce mean sequence length from 1,250 to 158 tokens and mean peak training memory from 5.21 to 0.27 GB. The results show that aligning tokens with ECG morphology can improve both predictive performance and memory efficiency without increasing backbone capacity. The source code is available on https://github.com/LeeJarvis996/ecg_tokenizer.