A Hybrid CNN--State-Space--Attention Backbone with Joint-Embedding Predictive Pretraining for 12-Lead ECG Classification

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.

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.

Electrocardiography (ECG), photoplethysmography (PPG), and phonocardiography (PCG) provide complementary views of the same cardiac cycle, yet existing cardiac foundation models are trained for a single sensing modality, leaving the shared physiology across sensors unexploited. We introduce CardioState-JEPA, a cardiac foundation model to learn a single shared representation jointly across ECG, PPG, and PCG, built on a physiology-aware joint-embedding predictive architecture. The model maps heterogeneous waveforms into a common token space, processes them with a single shared Transformer encoder, and learns by predicting masked latent cardiac states, placing the pretraining target on shared physiology rather than sensor-specific waveform appearance. To handle the temporal offsets between electrical, mechanical, and hemodynamic events, cross-modal prediction uses a learned delay aligner that matches signals at the corresponding cardiac time. Because synchronized multi-sensor recordings are scarce, CardioState-JEPA first learns within-modality structure from abundant unimodal data and then uses paired data to align modalities in latent cardiac time. Evaluated as a frozen encoder across 25 downstream tasks spanning ECG, PPG, and PCG, our encoder improves average PPG classification by 8.2 AUROC points, PCG murmur detection by 18.8 AUROC points, and ECG classification by 15.5 AUROC points over the best self-supervised signal baseline and matches or exceeds cardiac models trained with privileged clinical text or supervised labels on several ECG benchmarks. These results establish that heterogeneous cardiac signals can mutually supervise a single foundation model of cardiac physiology.