Electrocardiogram Foundation Models

Paper ECG recognition is challenging because real-world ECG images vary in layout, physical artifacts, and label availability. We introduce RobECG-CL, a rank-aware contrastive learning framework for robust paper ECG representation learning. Starting from standard 12-lead ECG recordings, we construct progressively degraded paper ECG views with heterogeneous layouts and train the model to balance same-recording invariance with degradation-aware ordering. Across synthetic stress tests on CODE-II and EchoNext, RobECG-CL improves robustness under severe degradation and few-shot transfer, outperforming contrastive learning baselines and surpassing the waveform-based foundation model, ECG-FM, in the 1% labeled setting. On 312 samples of hospital data with 37 labels, RobECG-CL achieves the best macro AUROC.

Electroencephalography (EEG) is recorded continuously over hours, with relevant dynamics spanning timescales from milliseconds to hours. Most EEG foundation models nevertheless process fixed windows independently, limiting their ability to capture information encoded in long-timescale dynamics. State-space architectures enable persistent recurrent processing, but long-range information remains implicitly compressed in recurrent states. We present NeurDuo-EEG, a causal EEG foundation model with channel-resolved persistent memory. NeurDuo-EEG introduces multi-timescale memory management with learned consolidation and selective retrieval, enabling persistent modelling of continuous EEG with fixed-size state. It is pre-trained on 3,955 hours of EEG from 17 public datasets using multichannel autoregressive prediction of discrete spectral codes. Across three short-window and two long-sequence downstream tasks, NeurDuo-EEG achieves the best performance on four of five benchmarks, including all three short-window tasks and seizure detection, where AUC-PR improves from $0.285$ to $0.471$ over the strongest non-NeurDuo baseline. NeurDuo-EEG also remains competitive on sleep staging and supports efficient streaming inference, with nearly constant per-chunk latency as the available history grows to one hour. Notably, the Small variant achieves this with only 4.7M backbone parameters. These results demonstrate the value of persistent, multi-timescale modelling for both long-sequence and short-window EEG analysis. Our code is available at https://github.com/YifaNNW/NeurDuo-EEG.

Clinicians and neuroscientists have long analyzed intracranial electroencephalography (iEEG) through directly measurable physiological characteristics, which carry much of the information that downstream tasks depend on. Recent iEEG foundation models learn by reconstructing or predicting their inputs, which leaves the retention of these characteristics implicit. They are also evaluated mainly on cognitive decoding and a narrow clinical task, i.e., seizure detection. On a broad, clinically relevant benchmark such as Omni-iEEG, they remain below task-specific models when used frozen. We introduce PHASE, a physiology-guided foundation model that makes these characteristics explicit learning targets, pairing them with masked latent prediction in a temporal stage (PHASE-T) within each channel and a spatiotemporal stage (PHASE-ST) across synchronized channels. PHASE is pretrained on heterogeneous recordings from 222 participants at nine clinical sites. On all five Omni-iEEG clinical tasks, frozen PHASE-T outperforms every evaluated foundation model by up to 31%, and fine-tuned PHASE-T surpasses the task-specific models, setting a new state of the art. PHASE-T benefits from physiological supervision, outperforming variants trained with latent prediction alone or auxiliary waveform reconstruction on every task in matched ablations. PHASE-T generalizes to unseen institutions, outperforming the compared models with few or no local labels. PHASE-ST further improves seizure-onset-zone identification over PHASE-T and, when frozen, decodes sound volume and pitch on BrainTreebank better than published models. Beyond task performance, PHASE learns to encapsulate the physiological characteristics clinicians recognize, from seizure onset and its propagation to anatomical region identity, even though its pretraining contains no ictal recordings or anatomical labels.

TRACE (Text-Reinforced Analysis of Cardio ECGs) is a multimodal electrocardiogram (ECG) representation model that learns clinically grounded signal embeddings for downstream cardiac classification. It is designed to address the limitations of existing CLIP-style training, which often struggles with noisy clinical text and fails to leverage the complementary strengths of unimodal (from ECG) and cross-modal (between ECG and matched cardiologist reports) learning. To bridge this gap, we propose a hybrid architecture that jointly learns unimodal and cross-modal representations via uncertainty-weighted multi-task learning while utilizing an LLM-based pipeline to extract high-fidelity findings from cardiologist reports. We evaluate TRACE across a spectrum of clinical urgency, establishing robust performance on public benchmarks for arrhythmia classification and structural abnormalities relative to existing unimodal and multimodal ECG models. To demonstrate real-world utility, we further validate the model on acute coronary occlusion (ACO), where the prevailing ST-elevation criteria miss 25-34% of true occlusions. Utilizing a large private ACO dataset with expert-annotated ground truth, TRACE significantly outperforms real-world clinical practice, yielding a 19.0% increase in sensitivity or a 62.6% reduction in false positive rates at the clinical baseline. This extensive evaluation confirms that TRACE delivers both strong performance on benchmark tasks and tangible clinical impact in the most acute, high-risk cardiac scenarios.

Estimating electrocardiography (ECG) from a chest-worn inertial measurement unit (IMU) enables continuous heart rate (HR) monitoring without the discomfort of electrodes. We propose TinyCardioUNet, a lightweight UNet that uses all six IMU axes without prior channel selection, refines its bottleneck with a graph neural network that encodes inter-axis dependencies, and employs tensor decomposition with automatic variational Bayesian rank selection for parameter reduction. On a public dataset, TinyCardioUNet achieves an RMSE of $0.098$ and a Pearson correlation coefficient of $0.677$ with only $36.0$k parameters and remains comparatively robust to additive noise, demonstrating accurate ECG reconstruction with a compact model.

Reconstruction-based unsupervised learning can fail in two opposing ways: a model may reconstruct anomalies too accurately or discard valid nominal variation. Using the Pursuit of Subspaces hypothesis, we characterize these failures through the meet, union, and join geometries induced by the nominal components. Excess learned range produces join blindness, while insufficient capacity produces meet preference and loss of nominal fidelity. We show that the compact nominal union is optimal among nominal faithful ranges and generally requires a nonlinear reconstruction map. Based on this geometry, we introduce Dynamic Push and Pull, which learns from controlled perturbations without anomaly labels, and nested manifold carving, which applies the same principle recursively in latent space. Experiments confirm the predicted changes in latent geometry across every tested Push and Pull configuration. The proposed methods improve reconstruction-based anomaly detection across standard benchmarks and unseen image degradations, while also improving pretrained ECG representations for downstream classification. These results connect reconstruction failures to identifiable geometric conditions and provide practical mechanisms for learning compact representations.

Electrocardiography (ECG) contains subject-specific morphology that supports biometric recognition, yet image-based performance depends on how the waveform is rendered. We introduce representative-morphology heatmaps, a deterministic ECG-to-image representation adapted from ECGXtractor. Within each block of ten aligned beats, the five beats closest to the block mean are averaged into a 400 by L matrix and rendered either as a conventional trace or as a dense cardiac-time-by-lead heatmap. Since both representations contain identical physiological samples, their comparison isolates the effect of rendering. We evaluate verification and closed-set identification on PTB, ECG-ID, and MIMIC-IV-ECG-DEMO. Five compact models, including ZACH-ViT, are trained from scratch, while six ImageNet-pretrained CNN and transformer backbones assess model scale and visual transfer. Heatmaps improve both FNMR operating points and both identification ranks in all 15 compact model-dataset comparisons, while EER improves in 14. Across the matched experiments, EER decreases by 9.59 percentage points and Rank-1 increases by 24.69 points on average. ConvNeXt-Tiny reaches 2.43% EER on PTB and 5.79% on ECG-ID, whereas DeiT-Base reaches 14.92% on MIMIC-DEMO. ImageNet initialization clearly benefits the two multilead datasets but has a mixed effect on ECG-ID, and performance does not increase monotonically with model size. The best heatmap systems approach the strongest signal-domain EER on PTB and ECG-ID, while DeiT-Base provides the strongest evaluated performance on MIMIC-DEMO. Lead-channel ablation further shows that useful channel combinations depend on the cohort and biometric task. Overall, representative-morphology heatmaps provide an effective image representation for ECG verification and identification.

Public surface electromyography (EMG) datasets vary widely in electrode layout, channel count, frequency support, and size. Simply mixing them for pretraining can misalign channel semantics, introduce spectral targets that some devices cannot observe, and let large or high-channel-count datasets dominate learning. We introduce EMGBlend, a self-supervised framework designed around these differences. It combines shared channel patches with geometry-aware attention, restricts spectral targets to each recording's supported frequency band, and balances exposure across data sources. We pretrain a 109M-parameter model on 11 public EMG sources and evaluate it on gesture recognition, continuous-force regression, and contact classification. EMGBlend consistently outperforms matched random initialization and waveform reconstruction controls. Fixed-budget source controls show that multi-source pretraining improves gesture recognition and remains competitive for force decoding. Ablations confirm that geometry, band-aware targets, and source balancing each contribute to transfer, although cross-person NinaPro force estimation remains difficult. Overall, EMGBlend shows how heterogeneous EMG datasets can be combined through explicit mechanism design rather than simple concatenation. Code is available at https://github.com/tamanano/EMGBlend

Deep learning has advanced automated electrocardiogram (ECG) diagnosis, but the field's most accurate models, foundation models pretrained on millions of recordings, are not decision-pathway auditable: a clinician cannot trace a diagnosis to a physiological pathway or intervene on one. We propose TRACE, a Tractable Routing Autoencoder for Clinical ECG, whose 32-dimensional clinical latent space is specified in advance from domain knowledge rather than discovered by optimization. TRACE partitions this space into perfusion, structure, and conduction subspaces, routes each to its own diagnostic head by design, regularizes the partition with an orthogonality penalty, and reconstructs the ECG through a decoder that permits latent perturbation. On PTB-XL and Georgia, TRACE exceeds unconstrained classifiers and stays ahead of an ECG foundation model pretrained on ten million recordings, evaluated by linear probe on frozen features, at roughly an eighth of the parameter count. On the nine-label CPSC2018 cohort, which carries no structural class, the framework transfers with only the routing table re-specified to a perfusion/rhythm/conduction partition. Joint probe, erasure, and perturbation analyses verify the routing contract, and perturbing the depolarization and repolarization pathways modulates the reconstructed waveform. Removing the specified partition and its orthogonality penalty costs 1.70 AUC and 11.30 macro-F1 points on PTB-XL, and 2.76 AUC and 16.92 macro-F1 points on Georgia. A capacity-matched permutation control places arbitrary assignments within 0.34 AUC points of the ontology routing and leaves macro-F1 statistically level (p=0.619): the ontology supplies decision-pathway auditability at no macro-F1 cost.

Effective EEG decoding requires representations that preserve organization among channels, local waveform dynamics, and long-range temporal context. Existing EEG architectures often capture these structures using separate specialized modules or collapse them into a single token sequence, making it difficult to maintain their distinct roles and coordinate their interactions throughout the backbone. We propose TriDim, a reusable block that preserves the representation shape and keeps three EEG axes explicit: channel, sample position within each patch, and patch position across the recording. These axes correspond to spatial, short-term temporal, and long-term temporal information, respectively. Each TriDim block applies feed-forward transformations along individual axes and cross-axis attention to coordinate information exchange among them. By stacking TriDim blocks with a multi-level tri-axis readout, we construct TriDimEEG, a standalone EEG decoder. Under strict cross-subject evaluation on eight datasets spanning clinical diagnosis, sleep staging, motor imagery, and emotion recognition, TriDimEEG achieves the best overall performance among fifteen evaluated models, with a 4.3% relative improvement in average accuracy over the second-best model. Replacing Transformer blocks in three EEG foundation models with TriDim blocks yields an average relative improvement of 7.4% in downstream accuracy while reducing parameter counts by 17.0% to 47.3%. These results establish TriDim as an effective and reusable building block and TriDimEEG as a strong standalone EEG decoder. Code and parameters of TriDimEEG are available at https://github.com/ncclab-sustech/TriDim_model.

Cardiovascular diagnosis rests on integrating complementary modalities, like ECG, echocardiography, chest radiographs, and clinical variables, each capturing distinct but correlated aspects of cardiac physiology. Yet most medical foundation models remain modality-specific, combining modalities only for finetuning or post-training. This discards the cross-modal evidence clinicians naturally integrate and ignores the structure within each modality. We introduce Latent-Attention Masked Autoencoders (LAMAE), a multimodal, structure-aware masked autoencoder that jointly learns patient-level representations during self-supervised pretraining. Rather than fusing modalities post hoc, LAMAE exchanges information directly in the latent space through a shared latent-attention module operating over a study-view-entity hierarchy, enabling aggregation of variable observations and graceful handling of missing modalities. Pretrained on over 1.2 million MIMIC-IV hospital stays, LAMAE outperforms modality-specific pretraining and strong contrastive and vision-language baselines across multimodal hospital-stay tasks, such as in-hospital mortality, ICD-10 and DRG coding, and length of stay, while remaining competitive on unimodal tasks. These gains persist even when only a single modality is available at test time, showing that modeling both intra- and inter-modal structure yields more robust, transferable representations.

Learning robust representations for time-series signals under noise and distribution shifts remains challenging, especially in clinical applications such as electroencephalogram (EEG) and electrocardiogram (ECG) analysis. We propose Diffusion-Conditioned Representation Alignment (DCRA), a training framework that repurposes the forward diffusion process as a structured corruption scheduler for representation learning. Different from conventional augmentation and consistency-based methods that rely on independently sampled perturbations, DCRA introduces a structured corruption trajectory via the diffusion forward process, which enables continuous and controlled representation evolution across noise levels. We introduce a feature-level consistency objective that aligns representations across noise levels while preserving class-discriminative structure. This mechanism promotes structure-preserving consistency, which enables smooth and semantically coherent feature trajectories in latent space. The proposed framework is encoder-agnostic and can be integrated with state space models and Transformer architectures. The seizure detection experiments on the CHB-MIT EEG dataset show that DCRA consistently improves performance under multiple noise conditions and achieves higher sensitivity at low false-positive rates. Analysis reveals that DCRA produces more balanced and structured representations compared to baseline and diffusion-only models. These findings highlight the benefit of combining structured corruption with representation alignment for robust time-series learning.

Masked reconstruction is widely used for EEG foundation models, but optimizing reconstruction on low-SNR waveforms does not necessarily produce the most useful latent representation. We introduce MANAS-2, a new EEG foundation model that combines a Raw-Band Hybrid (RBH) masked autoencoder with Constrained Reconstruction (ConRec), a physics-motivated regularizer. RBH jointly reconstructs temporal waveform patches and compact spectral-band targets, while ConRec acts only on the temporal decoder output, penalizing differences in RMS energy between adjacent short windows of the reconstructed waveform. ConRec is intended to shape the encoder by biasing it toward the organization of oscillatory-envelope information. Across seven held-out EEG datasets, adding ConRec to an otherwise identical RBH model increases frozen ridge recovery of six-band spectral power from mean R^2=0.860 to 0.906 and recovery of inter-patch band-energy dynamics from R^2=0.283 to 0.354, while temporal waveform information remains highly recoverable from the frozen latents. Applied to a temporal-only masked autoencoder, ConRec also improves frozen downstream transfer and frequency-dependent latent geometry despite receiving no spectral targets: i.e., the effects of ConRec are architecture-independent. MANAS-2 also outperforms leading EEG Foundation Models on most downstream knowledge-transfer tasks. From the effects of ConRec, we see that a physically motivated constraint imposed through the decoder can make for a more spectrally organized and transferable latent space. MANAS-2 therefore provides a new EEG foundation model built around constrained reconstruction as a mechanism for shaping representation--rather than reconstruction--quality.

Chagas disease is a major cause of cardiomyopathy in Latin America. Cardiac magnetic resonance (CMR) imaging can characterize its structural abnormalities, but scanners and expert readers remain scarce in endemic regions. Electrocardiography (ECG) is inexpensive and widely available, yet structural disease must be inferred indirectly from electrical signals. We propose to transfer CMR-derived structural knowledge to ECG through contrastive pre-training. Using 63,193 paired ECG-CMR examinations from the UK Biobank, we align an ECG encoder with a clinically grounded CMR embedding space using an asymmetric InfoNCE objective. Despite seeing no Chagas cases during pre-training, the resulting representation improves ECG-based Chagas detection. Across CODE-15% and SaMi-Trop, a frozen linear probe achieves an AUROC of 0.851 and sensitivity at the top 5% of predicted risk (Top5%-TPR) of 0.427 in five-fold cross-validation, compared with 0.827 and 0.377 for an unaligned ECG-FM baseline. On the PhysioNet/CinC 2025 Challenge test set, our model obtains the highest AUROC on SaMi-Trop-3 and the best ELSA-Brasil challenge score among the three top-performing methods, indicating that imaging-supervised ECG representations can generalize to populations and settings beyond the pre-training distribution.

Electroencephalography (EEG) is a non-invasive technique for measuring neural activity and has been widely used in neuroscience applications. Recent advances in EEG foundation models have enabled strong performance across diverse neural decoding tasks. However, no single foundation model consistently performs best across datasets or individual EEG instances, while instance-level model selection remains largely unexplored. To address this limitation, we formulate EEG foundation model selection as an instance-level Algorithm Selection (AS) problem. We propose \textbf{EEG-AS}, an instance-level algorithm selection framework that characterizes each EEG instance using inference-available latent EEG embeddings, handcrafted neurophysiological features, and an anchor foundation model. During training, EEG-AS learns to reconstruct unavailable foundation-model behaviors from privileged prediction tokens conditioned on an anchor foundation model, while during inference it estimates these behaviors without executing the entire model portfolio, enabling efficient selection from seven EEG foundation models. Experiments on seven public EEG benchmarks demonstrate that EEG-AS substantially narrows the gap between the Single Best Solver (SBS) and the oracle upper bound for each instance. These results highlight the effectiveness of instance-level AS for adaptive deployment of EEG foundation models.

We propose EEG-VID, a task-guided latent predictive pretraining framework for EEG decoding under session and subject shifts. EEG-VID predicts future latent EEG states from recent history using an exponential-moving-average target encoder and weak task guidance, followed by supervised fine-tuning. Across VIG-48 and BCI Competition IV-2a/IV-2b, Stage 1 improves mean accuracy in 41 of 42 matched backbone-dataset-protocol comparisons, including all 12 leave-one-subject-out settings, with a maximum gain of 16.22 percentage points. On the 48-region cross-day VIG-48 task, EEG-VID achieves 6.52% Top-1 and 30.50% Top-5 accuracy. In a separate six-participant offline robot-scene study, candidate-constrained target selection reaches 40.24% versus a 25% chance level after subject-specific calibration. These results support task-guided latent prediction as a transferable pretraining strategy for EEG decoding and scene-constrained assistive target selection.

Motor imagery (MI) electroencephalography (EEG) decoding could support post-stroke rehabilitation, but models developed on healthy cohorts may not transfer reliably to pathological EEG. We evaluated whether Low-Rank Adaptation (LoRA) can efficiently adapt three pretrained EEG foundation models (i.e., LaBraM-base, REVE-base, and REVE-large) for binary left- versus right-hand MI decoding. Frozen-backbone head-only baselines and LoRA adaptation were evaluated using subject-wise five-fold cross-validation on the PhysioNet EEG Motor Movement/Imagery Dataset and a binary subset of the UET175 dataset comprising 30 stroke participants. On EEGMMIDB, LoRA increased accuracy to 0.822 for LaBraM-base and 0.957 for REVE-base. On UET175, all head-only models performed near chance. With LoRA, LaBraM-base remained near chance (0.499$\pm$0.009), whereas REVE-base reached 0.847$\pm$0.194 and outperformed REVE-large (0.806$\pm$0.178), indicating that increased model capacity alone did not improve stroke-domain adaptation. The strongest stroke configuration, REVE-base LoRA, was further evaluated using within-cohort leave-one-subject-out cross-validation (LOOCV), showing 0.952 mean accuracy, but subject-wise accuracy ranged from 0.586 to 1.000, revealing a small low-performing tail. Zero-shot transfer from EEGMMIDB to UET175 remained near chance (0.464$\pm$0.072). These findings show that healthy-benchmark performance does not ensure transfer to stroke EEG. Translation of EEG foundation models to pseudo-online or real-time rehabilitation BCIs should therefore include target-domain adaptation and subject-level assessment of temporal informativeness, spatial sensitivity, and physiological discriminability.

Electrocardiogram (ECG) interpretation requires knowledge of cardiology, electrophysiology, clinical diagnosis, ECG waveforms, signal acquisition, and instrumentation. Existing language-model benchmarks, however, primarily assess broad medical knowledge or interpretation of individual ECG signals and images rather than the broader contextual knowledge required for ECG interpretation. We developed ECGQuest, a literature-grounded resource for evaluating and fine-tuning ECG-specific language models. A GPT-4o-based pipeline generated questions from 23 ECG references and Computing in Cardiology proceedings from 2003-2025. The final dataset contains 10,904 unique True/False questions paired with their negated forms (21,808 Q&A pairs). We evaluated three commercial and 20 open-source language models on a held-out test set in a zero-shot setting. Five open-source models with 7-14B parameters were fine-tuned using Low-Rank Adaptation, with BERT and BiomedBERT included as supervised encoder baselines. Generalization was assessed on ECG-related subsets of MedMCQA and MedQA converted to binary True/False questions using official answer keys. Zero-shot accuracy on ECGQuest ranged from 49.5% to 74.4%, with GPT-5 performing best. General-purpose models outperformed medically specialized models, several models showed strong True/False bias, and encoder baselines performed near chance. Fine-tuning improved all open-source models by 6.5-14.1%. Fine-tuned DeepSeek-R1-Distill-Qwen-14B reached 76.3% accuracy, while a five-model voting ensemble reached 78.5%. On MedMCQA and MedQA, fine-tuning mainly benefited weaker or class-biased models and did not consistently improve strong base models. ECGQuest provides a reproducible benchmark for contextual ECG knowledge and shows that parameter-efficient fine-tuning can make smaller language models competitive with substantially larger commercial models.

Electroencephalography (EEG) decoding models often generalize poorly across datasets and subjects due to domain shifts in acquisition protocols and individual neurophysiology. We propose EEG-PRIME, a two-stage EEG foundation model for cross-dataset multi-task decoding. EEG-PRIME combines masked pretraining with prototype-aligned instruction tuning to enable instruction-aware and subject-invariant decoding across diverse BCI paradigms. During pretraining, an EEG encoder learns transferable representations through masked reconstruction with frequency-cutoff spectral augmentation. During instruction tuning, EEG-PRIME incorporates task-semantic, dataset-specific, and subject-invariant conditioning. The resulting conditioning signal modulates the Q-Former through Layer-wise Query Modulation, while frozen text embeddings of class labels serve as prototypes for cosine-similarity-based prediction across heterogeneous label spaces. Experiments on sixteen datasets covering motor imagery, emotion recognition, ADHD detection, covert speech, and mental workload show consistent improvements over state-of-the-art baselines and prior EEG foundation models under cross-subject settings. On two additional held-out datasets, EEG-PRIME achieves balanced accuracy comparable to within-session calibration models without target-domain optimization, calibration, or linear probing, demonstrating promising zero-shot transfer capability.

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.

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.

Recent advances in EEG foundation models have demonstrated the potential of large-scale pretraining to enable generalizable neural decoding across subjects, recording environments, and datasets. However, dominant pretraining paradigms face key challenges: masked autoencoding tends to prioritize low-level signal reconstruction over task-relevant semantics, while autoregressive modeling creates a mismatch between continuous neural dynamics and discrete token spaces. To address these challenges, new strategies are needed to effectively align continuous EEG representations with natural-language semantics and enable their integration with large language models. Accordingly, we propose Brain Latent Predictive Model (BLPM), an EEG-language foundation model that reformulates heterogeneous EEG decoding tasks as a continuous semantic embedding prediction problem. BLPM introduces a Continuous EEG Latent Predictive (CELP) encoder that learns transferable representations through latent target prediction. Building on these representations, a Multi-Query Semantic Decomposition (MQSD) module extracts task-relevant information and aligns continuous EEG representations with textual semantics within a shared latent space according to their semantic relationships. Experiments across multiple benchmarks demonstrate consistent generalization performance across diverse tasks, establishing continuous latent semantic prediction as an effective paradigm for EEG-language foundation models.

Cardiologists interpret electrocardiograms by localizing waveform components, measuring rhythm and interval patterns, and translating these structured observations into diagnostic evidence. Whether this expert reading process can serve as an effective prior for ECG agents remains unclear. To address this question, we introduce LuminaECG, a clinically structured ECG reasoning framework that reformulates ECG interpretation as measurement-grounded visual reading. ECG signals are rendered on standard electrocardiographic grid paper to preserve the spatial and scale cues used in clinical reading. P-wave, QRS-complex, and T-wave boundaries are explicitly delineated, and color-coded segmentation decomposes the waveform into discrete visual measurement primitives. A general 2B vision-language backbone is then trained with low-rank supervised fine-tuning to associate these primitives with diagnostic reasoning, without architectural modification. Across open, proprietary, and ECG-specialist zero-shot baselines, LuminaECG improves both waveform measurement and diagnostic recovery. It reaches a clinically meaningful reader tier on the CODE-test benchmark, transfers across geographically diverse ECG datasets without retraining, and generates reports whose structure contains an emergent prognostic signal. These findings suggest that effective ECG agents require not only larger models, but supervision that preserves the alignment between measurable waveform evidence and clinical knowledge.

This work investigates whether Electroencephalograph (EEG) foundation models (EFMs) can be made faster and locally deployable without sacrificing accuracy. EEG foundation models are a major trend, offering strong general-purpose representations. However, their computational burden grows quadratically with input length, hindering deployment on resource-constrained scenario, particularly for real-time clinical monitoring. EEG's low SNR further suggests many of these tokens are redundant and compressible with little accuracy cost. We propose ZIPBrain, a novel redundancy-aware EEG token pooling module that leverages this low-SNR characteristic to reduce token count. Given a token sequence, ZIPBrain partitions tokens into redundant and unique groups, then merges each redundant token with its most similar counterpart in the unique group. Furthermore, ZIPBrain serves as a training-free, plug-and-play module that seamlessly integrates into standard Transformer encoders with negligible computational overhead. Extensive experiments across multiple EEG foundation models show ZIPBrain's strong versatility, achieving 1.3%-10.5% average improvement over baselines, while reducing wall-clock inference time by 32.7% (up to 41.8% with CUDA Graph) compared to the original EEG foundation models.

Point-of-care cardiac devices such as smartwatches and handheld ECG recorders typically capture 1--2 leads, yet existing ECG foundation models are architecturally constrained to fixed 12-lead inputs, degrading or failing under these reduced configurations. We introduce LAEF (Lead-Agnostic ECG Foundation), a 7M-parameter ECG foundation model that can natively process any lead subset without zero-padding or architectural modification. LAEF represents ECGs as variable-size spatiotemporal graphs with physiologically motivated intra- and inter-lead connectivity, processed by a Graph Attention Network that scales naturally with active lead count.Pre-trained on 9.2M 12-lead ECGs via masked node modelling with stochastic lead sampling, LAEF learns representations robust to lead configuration. Across 18 downstream datasets, LAEF is on par with specialized 12-lead baselines over 12$\times$ larger at full lead availability. Under direct point-of-care-oriented diagnostics (1--2 leads), it outperforms all zero-padded alternatives on 17 out of 18 datasets with with a single randomly sampled lead and on 14 out of 18 with 2 leads, with an average AUROC gain of +3.2 points. Representation analysis links this advantage to architectural lead-agnosticism, and a lead-importance study across 164 cardiovascular conditions shows population-level performance is stable across single standard input leads while still recovering established clinically lead-condition associations.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with increased risks of stroke, heart failure, and mortality. Recent ECG foundation models offer transferable representations for automated AF detection. However, their relative effectiveness remains unclear because existing studies use different datasets, preprocessing procedures, classifiers, and validation protocols. This study presents FOUND-AF, a unified, leakage-controlled, and deployment-oriented benchmarking framework that evaluates the quality of pretrained ECG representations under identical experimental conditions. Nine publicly available foundation models from five families, including HuBERT-ECG, CLEF, ST-MEM, ECG-JEPA, and ECGFounder, were evaluated across four heterogeneous ECG datasets, namely AFDB, CinC2017, CPSC2021, and LTAFDB. All models were used as frozen feature extractors with standardized preprocessing, model-native resampling, a fixed XGBoost classifier, and recording-level grouped cross-validation. The evaluation included classification metrics, receiver operating characteristic analysis, paired recording-level bootstrap comparisons with Holm correction, embedding-space visualization, and computational efficiency profiling. The ECGFounder model consistently achieved the strongest overall performance across datasets while offering a favorable trade-off between accuracy, model size, inference time, and memory usage. FOUND-AF therefore provides a reproducible framework for selecting ECG foundation models and demonstrates that compact, clinically pretrained encoders can support robust and computationally efficient AF detection across heterogeneous acquisition settings.

Increasing EEG pretraining data scale or model capacity does not consistently improve downstream performance. We identify a persistent low-frequency bias in representations learned by diverse EEG foundation models, which remains across dataset scales, model capacities, and pretraining objectives. Our analysis links this bias to the interaction between EEG's $1/f^α$-like spectral structure and neural networks' tendency to preferentially learn low-frequency components. In masked autoencoders, the $\ell_2$ reconstruction objective further amplifies this imbalance: under comparable relative reconstruction errors, high-power low-frequency components contribute disproportionately to the loss. To address this issue, we introduce FAME, a frequency-balanced masked autoencoding framework that reconstructs time--frequency activity in predefined EEG bands from masked EEG inputs. FAME independently standardizes the reconstruction targets within each band and assigns equal weight to all band-specific losses, thereby balancing supervision across the EEG spectrum. Evaluated on 41 downstream tasks in OmniEEG-Bench, FAME learns more spectrally balanced representations and achieves state-of-the-art performance on 24 of them. These results underscore the importance of balanced spectral supervision for learning transferable EEG representations.

Electroencephalography (EEG) foundation models aim to learn reusable representations from large-scale unlabeled recordings. A common pretraining strategy is masked waveform reconstruction, but applying supervision directly to noisy EEG may encourage models to recover predictable background activity, acquisition effects, and artifacts rather than neural structure that transfers across tasks. This raises a central question: what should an EEG foundation model predict to learn transferable representations? We introduce EEG-JEPA a structured latent-prediction framework for EEG foundation modeling. Rather than reconstructing masked voltage samples, a masked context encoder and predictor infer contextual latent states produced by an exponential-moving-average target encoder that observes the complete input. EEG-JEPA organizes target design along three complementary dimensions: target content specifies what representation is predicted, target support specifies where prediction occurs over structured electrode--time regions through Neurotopology-Aware Multi-scale Electrode-Temporal Masking (N-MET), and target depth specifies at which encoder layers supervision is applied. Together, these designs shift EEG pretraining from recovering missing measurements to inferring latent states from structured electrode--time context. We evaluate EEG-JEPA through controlled objective comparisons, frozen multitask transfer, and full fine-tuning. Under the same backbone, pretraining corpus, and training duration, EEG-JEPA improves the 14-task frozen macro balanced accuracy from 40.49% to 50.42% over CBraMod-style masked waveform reconstruction. Multi-source continuation further raises this result to 52.94%, the highest average among the EEG foundation models evaluated on EEG-FM-Bench. Under protocol-matched full fine-tuning, EEG-JEPA also improves the nine-task average balanced accuracy from 68.98% to 70.65%.

Existing benchmarks for electrocardiogram foundation models primarily evaluate downstream predictive performance, providing limited insight into whether their internal representations can be faithfully decomposed, clinically interpreted, or reproduced across independent analyses. We introduce ECG-InterpBench, a benchmark designed to systematically evaluate the interpretability of ECG foundation-model representations. ECG-InterpBench uses sparse autoencoders as standardized measurement instruments and matches their capacity across models to enable controlled comparisons. We evaluate six frozen ECG foundation models across five standardized encoder depths, five matched dictionary widths, and three random seeds, producing a 450-cell interpretability atlas comprising 75 exactly matched six-model comparison blocks. The benchmark evaluates complementary dimensions of representation interpretability, including sparse reconstruction fidelity, single-feature accessibility and coverage of 49 clinically meaningful ECG measurements, and cross-seed feature reproducibility. The evaluation further quantifies patient-sampling uncertainty, depth- and seed-dependent variation, and sensitivity to the sparsity parameterization. The benchmark reveals that ECG foundation models exhibit distinct interpretability profiles. A matched replication on MIMIC-IV-ECG confirms that reconstruction fidelity and clinical accessibility identify different leading models. The benchmark is accompanied by executable evaluation code, standardized manifests, cell-level metrics, and reproducibility audits. ECG-InterpBench complements performance-centered ECG benchmarks by providing a capacity-controlled and reproducible framework for comparing ECG foundation models across distinct dimensions of representation interpretability.

We introduce ZUNA1.1, a 380M-parameter diffusion autoencoder for flexible EEG signal reconstruction. ZUNA1.1 is capable of reconstructing variable length sequences of up to 30s, with an arbitrary number of EEG channels at arbitrary scalp locations, and can reconstruct arbitrary temporal intervals within channels in addition to reconstructing entire channels. We demonstrate that ZUNA1.1 performs at least on par with our earlier ZUNA1 model, while being far more flexible and capable of handling a wide range of reconstruction tasks. ZUNA1.1 continues to substantially outperform standard EEG denoising and reconstruction methods such as spherical spline interpolation, which is ubiquitously deployed in the MNE package. The ZUNA1.1 model is released open source under the permissive Apache 2.0 license.

Foundation models for 12-lead electrocardiograms (ECGs) transfer well across clinical tasks, but the physiological knowledge encoded in their representations remains opaque. We present CADENCE, a framework that decomposes an ECG foundation model into a human-interpretable, queryable dictionary of physiological concepts. Using a BatchTopK sparse autoencoder, CADENCE factorizes Layer-6 embeddings from more than nine million ECG tokens into 8,192 sparse cardiac atoms. These atoms align better than individual dense embedding dimensions with clinical phenotypes and waveform morphology, recovering arrhythmias, conduction abnormalities, infarction and repolarization patterns, chamber and axis findings, and lead- and beat-phase-specific waveform primitives. At Layer 6, the best atoms achieve mean AUROCs of 0.88 for clinical phenotypes and 0.90 for morphology, versus 0.78 and 0.83 for the best dense dimensions. Sparse atom probes match or outperform dense probes for phenotype, morphology, and age prediction while attributing each prediction to a small set of interpretable atoms; phenotype AUROC improves from 0.93 to 0.95. Atom-space geometry recovers physiologically coherent relationships, and targeted atom ablation selectively changes frozen downstream outputs. An automated LLM pipeline generates and quantitatively validates atom descriptions by predicting held-out activations. On independent external ECG datasets, CADENCE recovers overlapping concepts and maintains consistent phenotype-prediction performance. CADENCE provides a scalable framework for discovering and auditing the physiological knowledge encoded by ECG foundation models.

Standardized echocardiography conclusions provide meaningful supervision for learning ECG representations of echocardiography-derived cardiac findings. Global ECG--text alignment may entangle modality-specific factors, while long-tailed finding distributions provide sparse positive supervision for low-prevalence conditions. We propose EchoBridge with Complementary Shared--Private Projection (CSPP) and Adaptive Prototype Boundary Calibration (APBC). CSPP maps each modality into shared and auxiliary private projections, reduces directional redundancy via within-modality orthogonality, and bidirectionally aligns normalized shared projections. APBC organizes the shared hypersphere with class-specific prototypes, training-frequency-adaptive angular margins, and spherical Riesz repulsion. We evaluate EchoBridge on EchoNext-Mini and independent PKUPH and SHTMU cohorts under four protocols: prompt-based inference without downstream classifier training, in-domain frozen linear probing, target-domain cross-center frozen linear probing, and source-only cross-center transfer, supplemented by finding-specific analyses. EchoBridge improves classifier-free AUROC, AUPRC, and F1 over the strongest baselines by 7.88, 5.61, and 4.54 points, respectively, and achieves the highest point estimates across all in-domain and target-domain probing budgets and both source-only transfer cohorts. Finding-specific analyses show gains for most conditions, including several low-prevalence valvular findings.

Pretrained EEG foundation models are proposed for clinical decoding, but whether reported gains transfer across populations or survive negative controls is unclear. We benchmark LaBraM, EEGMamba, CBraMod, REVE, LEAD, BENDR, and BIOT on five clinical tasks across four datasets. Primary analyses use frozen linear probes with subject-disjoint LOSO or grouped five-fold validation. Because CAUEEG releases no patient identifiers, it is evaluated at recording level with a patient-disjoint sensitivity. We challenge apparent gains using stronger classical comparators, label permutation, scrambled-label fine-tuning, and random-initialisation controls. In a matched 19-channel CAUEEG evaluation (Normal/MCI/Dementia; N = 1,187 recordings), classical features achieve 0.734 macro-AUROC versus 0.699 for BIOT, 0.669 for CBraMod, and 0.568 for REVE. A patient-disjoint sensitivity retains the classical-over-REVE ordering (0.717 versus 0.565). Dataset identity is decoded from frozen REVE embeddings at or near ceiling across Western-Korean and Western-Western pairs, including after PCA-50 and removal of line-frequency and amplitude-scale information. This establishes dataset membership, not a causal site or population effect. A matched random-initialised encoder exceeds pretrained REVE on CAUEEG (0.659 versus 0.570). On CHB-MIT cross-subject ictal detection (n = 23), REVE reaches 0.793, versus 0.739 for the best enhanced nonlinear comparator, 0.701 for random initialisation, and 0.505 for raw-signal random features. Because preprocessing removes absolute amplitude, this does not establish superiority over every plausible handcrafted baseline. Conclusions change materially after montage matching, patient-overlap checks, stronger comparators, and representation controls. We distill these checks into a reporting protocol for clinical EEG foundation-model studies.

Electroencephalography (EEG) models used for epilepsy are often limited to specific datasets and tasks. This limited approach can make it challenging to apply these models across different datasets or in various situations. However, recent studies in foundation models and self-supervised learning suggest that an adaptable EEG backbone could support a range of EEG related tasks. In this study, we have developed a multimodal EEG foundation model that combines a raw signal encoder based on the Mamba architecture, a Vision Transformer (ViT)-style encoder for time-frequency data, and a lightweight encoder for text, all within a shared embedding space. The pretraining process relies on several innovative techniques, such as masked modeling, cross-view contrastive alignment, and temporal consistency losses. These methods are designed to create rich, seizure-relevant representations without requiring labeled data. To assess the efficacy and generalization of our pretrained model, we fine-tuned it on the canonical CHB-MIT seizure detection benchmark and additional seizure detection datasets, and conducted extensive experiments comparing different model variants. On the standard CHB-MIT split, our best single model achieved an AUROC of 0.874, and an ensemble variant reached 0.878 AUROC, representing state-of-the-art performance on this benchmark. In addition to standard train-test splits, we evaluated performance under a leave-one-subject-out (LOSO) protocol, which is rarely reported in prior EEG seizure modeling work and highlights the difficulty of patient-independent seizure detection, with a mean LOSO balanced accuracy of 0.558 across 19 subjects. Across datasets and evaluation settings, our multimodal foundation model enabled robust seizure detection and straightforward adaptation to new seizure detection scenarios, while also supporting interpretable seizure localization.

The electrocardiogram (ECG) is a cornerstone of cardiac as- sessment, yet clinical deployment of deep learning models remains con- strained by limited interpretability and the hallucination risk of large language models (LLMs). Existing CNN+Grad-CAM+multimodal LLM frameworks can generate ECG reports, but their explanations are often only weakly grounded in established diagnostic criteria, reducing trust- worthiness and reproducibility. We propose a guide-grounded multimodal framework that explicitly anchors report generation in curated clinical knowledge. A convolutional neural network (CNN) and Grad-CAM first produce class probabilities and class-specific heatmaps from 12-lead ECG images. In parallel, authoritative ECG textbooks and guideline materials are distilled offline into a structured ECG Interpretation Guide, which is injected as a fixed knowledge block for every sample. Conditioned on the ECG image, Grad-CAM overlay, CNN-derived fact pack, and the in- jected guide, a multimodal LLM generates structured diagnostic reports with guideline-consistent terminology and criteria usage. Experiments on the full PTB-XL test set demonstrate that guide grounding improves se- mantic quality and perceived consistency of generated reports while pre- serving competitive classification performance. In particular, our method increases the average BERTScore of generated impressions from 0.818 to 0.953 relative to a strong CNN+Grad-CAM+MLLM baseline, indicat- ing closer alignment with reference reports. These findings suggest that injecting a distilled interpretation guide into the multimodal prompting pipeline offers a practical pathway to reduce hallucinations and enhance the clinical plausibility of LLM-based ECG explanations, bringing ex- plainable cardiac diagnosis closer to real-world deployment.

Adult and pediatric electrocardiogram (ECG) interpretation relies on age-sensitive criteria, and models pretrained mainly on adult ECGs often transfer poorly to pediatric populations when pediatric labels are scarce. Existing multimodal ECG--text methods typically align waveforms and text at the global sample level, entangling evidence from co-occurring diagnoses and limiting transfer under this gap. We propose Pediatric-Adult ECG Alignment via Cross-modal Enhancement (PEACE), a knowledge-guided framework pretrained on the largely adult MIMIC-IV ECG corpus. PEACE describes each diagnosis along rhythm, morphology, and ST--T axes and, per recording, composes only positive-label descriptors into three axis tokens and a fused embedding. A label query network (LQN) uses diagnostic labels as queries to cross-attend over ECG tokens and axis tokens, while label set aware bidirectional contrastive learning (LSBC) aligns pooled ECG features with the fused embedding when recordings share diagnoses. Curriculum adaptive fusion (CAF) gates alignment strength according to smoothed classification loss and training progress, limiting disruption during early optimization. The knowledge branch is used only for training supervision; inference uses ECG signals alone. On ZZU-pECG, PEACE reaches macro average AUCs of 59.39%, 81.74%, and 91.56% under zero-shot, 50-shot, and full fine-tuning, with the clearest gains over foundation and knowledge-pretraining baselines under limited supervision; versus domain adaptation initializations, zero-shot improves substantially while 50-shot AUC is comparable to DANN. After fine-tuning on PTB-XL, PEACE reaches 96.90% macro average AUC over nine harmonized labels. Ablations confirm that label-conditioned knowledge alignment, rather than global text fusion, is the key driver of pediatric transfer gains.

Neurological prognostication after cardiac arrest commonly relies on electroencephalography (EEG). However, EEG demands high clinical resources. Bedside electrocardiography (ECG) is standard and low-cost. Yet, its value for predicting neurological outcomes remains underexplored. In this study, we propose NeuroECG, an ECGFounder-based deep representation framework for EEG-free auxiliary prognostication. NeuroECG adapts a pretrained ECG foundation model via task-specific fine-tuning. We implement a gradual unfreezing strategy on single-channel bedside monitoring ECG. Multiple ECG segments per patient are encoded into segment-level deep features. These embeddings are aggregated via quantile pooling (q = 0.24) and compressed using principal component analysis (PCA). Experiments on 412 ECG-available patients from the multicenter I-CARE database show that the adapted ECGFounder backbone achieves the best performance among ECG-only backbone baselines, with a test AUROC of 0.7333. We further combine the learned deep ECG representation with static clinical covariates. The proposed NeuroECG model achieves a test AUROC of 0.8077 and an AUPRC of 0.8970. These results support deep bedside ECG representations as a useful source of auxiliary prognostic information. Their integration with static clinical covariates improves prediction in an EEG-free setting. The source code is available at https://github.com/goddream66/NeuroECG

Electrocardiography (ECG) is one of the most widely used tests for diagnosing cardiovascular disease. Yet several remote clinics still utilize paper ECG printouts for their analysis due to limited connectivity and computational capacity. As a result, vast numbers of physical ECGs obtained in remote areas still remain incapable of being accessed by contemporary artificial-intelligence (AI)-based decision support as they require high computational resources or strong high-speed internet connectivity. This causes several cases where conditions like acute coronary occlusion (ACS) is overlooked and reperfusion therapy delayed. Although prior work has tackled digitization and diagnosis separately, and utilized advanced AI models for them, there still remains a lack of a compute-light, on-device framework that reconstructs paper ECGs at high fidelity, while accurately supporting multiple clinically relevant endpoints. We address this need with an end-to-end lightweight on-device digitization-to-diagnosis pipeline that converts a smartphone photo or scan of a paper ECG into a calibrated 12-lead signal and screens for Myocardial Infarction (MI) pathologies, with SHapley Additive exPlanations (SHAP) to support interpretability. Trained and evaluated on 21,799 ECGs from the PTB-XL dataset and further validated on hospital-acquired ECG-Matrix dataset, the complete system runs in <30 s per ECG on CPU-only resources, achieving 95.51% accuracy (F1 = 0.9519) for MI detection on PTB-XL and 88.89% accuracy (F1 = 0.8862) for OMI detection on ECG-Matrix. This work showcases that legacy paper records can be reliably democratized in any part of the world, providing a scalable decision support when digital ECG export, connectivity, or high-end compute are unavailable

Foundation models have recently emerged as a powerful paradigm for learning transferable representations from large scale biomedical data, yet existing approaches for physiological waveforms primarily optimize reconstruction or forecasting objectives that do not explicitly preserve clinically meaningful waveform morphology. Electrocardiograms (ECGs) and pulse oximetry (SpO2) waveforms encode rich cardiovascular and hemodynamic information through their morphological structure. In this work, we introduce MorphologyFM, a multimodal foundation model pretrained on paired ECG and SpO2 waveforms from the MIMIC critical care database using a morphology aware self supervised learning objective. MorphologyFM combines morphology guided masking, cross modal representation learning, and contrastive latent alignment to learn representations that capture clinically relevant physiological structure without requiring manual annotations. We evaluate MorphologyFM across multiple downstream prediction tasks, including arrhythmia classification, hypoxemia prediction, mortality prediction, and length of stay estimation, demonstrating consistent improvements over representative self supervised learning methods, including Masked Autoencoders (MAE), contrastive learning, Barlow Twins, and Joint Embedding Predictive Architectures (JEPA). Furthermore, we show that jointly modeling ECG and SpO2 waveforms produces more transferable representations than single modality pretraining. Our results establish waveform morphology as a powerful inductive bias for self supervised physiological representation learning and introduce MorphologyFM as a general purpose foundation model for continuous physiological monitoring.

Background: Foundation models (FMs) trained on large-scale unlabeled physiological data have emerged as a promising paradigm for medical artificial intelligence. Their ability to capture clinically meaningful, transferable representations for rare diseases remains largely unproven. This study investigates whether FM pre-training provides genuine clinical generalization benefits beyond improved optimization for rare electrocardiographic (ECG) phenotypes. Methods: We systematically evaluated nine publicly available ECG FMs for Brugada syndrome detection on the BrSwiss cohort (294 patients, 87 cases) and the independent external HUCA cohort (363 patients, 76 cases), under three strategies (from-scratch training, linear probing, full fine-tuning) across several configurations, including a 3% data ablation and zero-shot cross-site transfers. Results: Pre-training was necessary for high-capacity architectures unable to converge from scratch (AUC gain up to 0.411, p < 0.05), but gave no significant gain for compact architectures already converged on labeled data alone. On full BrSwiss, the best fine-tuned FM (ECG-CPC, AUC = 0.962) only marginally exceeded the strongest supervised baseline (ECG-CPC from scratch, AUC = 0.932; p = 0.091). At matched training-set size, the data-efficiency advantage on BrSwiss-3% (AUC gain = 0.055, p < 0.01) did not replicate on HUCA. Under zero-shot cross-site transfer, FM-based pipelines did not generalize better than supervised baselines, all approaching chance-level performance. Conclusion: For Brugada syndrome detection, FM pre-training is mechanical rather than semantic, providing optimization stability rather than transferable clinical knowledge. These findings challenge the assumption that large-scale pre-training inherently encodes clinically meaningful representations, highlighting the central role of model architecture and data-domain alignment.

In multi-source ECG deployment, new sources may arrive when earlier raw ECGs cannot be retained or replayed. Isolating source-specific classifiers on a frozen backbone prevents parameter interference, but source-unknown inference still requires selecting an appropriate expert. We study this distinction with IRFE-ECG, a controlled continual-deployment framework built on frozen 1024-dimensional ECGFounder features. Each arriving source adds an isolated Balanced-Softmax linear expert, while a lightweight router is re-fitted using retained frozen training features and source labels from previously observed sources. Rather than proposing a new routing architecture, the main contribution is to separate preserved expert performance from autonomous source inference and quantify the resulting deployment gap. Across CPSC, PTB-XL, Georgia, and Chapman-Shaoxing, source-aware expert selection reaches $0.7915 \pm 0.0036$ Macro-F1, close to a matched offline independent-head reference at $0.7885 \pm 0.0009$. Without source IDs, an MLP router reaches $0.7756 \pm 0.0027$, while top-2 margin fusion reaches $0.7782 \pm 0.0022$. The top-2 improvement is small (+0.0026) and not statistically significant under paired bootstrap. Across three domain orders, the top-2-to-oracle gap remains 0.0111-0.0133, indicating a persistent source-inference gap within this protocol. The results are record-level because reliable patient identifiers were unavailable. The method replays no raw ECGs, but it retains frozen feature vectors for router updates and is therefore raw-ECG-replay-free rather than memory-free. Code is publicly available at https://github.com/yufanlu221/IRFE-ECG.

New device layouts pose a challenging modeling problem due to the lack of large datasets for each specific layout. Biosignal foundation models offer a plausible solution if they are able to generalize to new layouts effectively. To improve cross-layout transfer, we study how different channel embedding techniques behave when pretraining layouts differ substantially from the downstream decoding layout. We propose Device Passport, a new channel embedding technique that learns experts and mixture models that take each channel's functional activity and metadata as input. This contrasts with prior embedding methods, which typically use only functional information or only metadata to look up learned or fixed positional embeddings. Across controlled subset-transfer experiments and realistic transfer to ear-EEG, Device Passport is competitive overall and improves over the strongest learned baseline in the layout-transfer regimes that motivate this work. These results suggest that channel embedding design is a key consideration when reusing large-scale pretrained biosignal models on new devices.

Self-supervised learning (SSL) is increasingly used in medical imaging to reduce annotation requirements, but representation quality is often judged using a single downstream evaluation setting. For dense clinical tasks, this can confound representation quality with the capacity of the downstream model used to recover task-relevant information. We present a systematic evaluation of self-supervised representations for left-ventricular segmentation and ejection fraction (EF) estimation from apical four-chamber echocardiography on EchoNet-Dynamic. Rather than relying on a single downstream probe, we compare a hierarchy of extraction strategies with increasing expressivity: heuristic extraction without mask-supervised training, frozen linear probes, frozen lightweight decoder probes, and partial fine-tuning. We apply this framework to two complementary representation families: generic frozen self-DIstillation with NO labels (DINOv3) features and a task-adapted dense self-supervised representation, Bootstrap Your Own Segmentation (BYOS). In both families, heuristic extraction substantially understated what was recoverable from the frozen representation. For DINOv3, performance improved from Dice 0.684 and EF mean absolute error (MAE) 13.01 under heuristic extraction to Dice 0.906 and EF MAE 9.65 with a frozen lightweight decoder, approaching a supervised U-Net baseline (Dice 0.915, EF MAE 9.72). For BYOS, performance improved from Dice 0.687 and EF MAE 17.83 under heuristic extraction to Dice 0.902 and EF MAE 8.74 with a frozen lightweight decoder. These results show that conclusions about self-supervised representation quality in dense echocardiographic analysis depend strongly on the downstream extraction strategy used for evaluation. We therefore argue that multi-strategy evaluation is an important methodological consideration for SSL in dense medical image analysis.

Physiological signals such as EEG, ECG, and PPG are widely used in clinical monitoring. Recent self-supervised learning (SSL) methods offer an attractive way to leverage unlabeled recordings, yet they still fall short in practice. In particular, current SSL methods struggle across heterogeneous datasets, often distorting clinically meaningful structures or learning shortcuts from temporal and cross-channel redundancy. Consequently, existing SSL methods often deliver limited performance under linear probing, a lightweight adaptation setting that better matches real-world medical scenarios. Moreover, most Transformer-based SSL models encode a flattened spatiotemporal token sequence, incurring high computation and memory cost, and are typically developed within a single modality. To address these limitations, we present SPOTR (Spatio-temporal Pooling One-Token Reconstruction), a compress-reconstruct pretraining framework that introduces a single-token global bottleneck for physiological signals. SPOTR compresses each waveform into a single-token representation and reconstructs the signal conditioned only on this representation. Meanwhile, SPOTR introduces an efficient spatio-temporal compaction module to reduce computation and memory cost. Pretrained on 20 datasets spanning EEG, iEEG, ECG, and PPG, SPOTR consistently outperforms the strongest baseline under linear probing, improving average AUC by 18.49%, 21.71%, 17.86%, and 4.64%, respectively. Compared with a representative general-purpose time-series foundation model, SPOTR achieves around 78% lower latency and 52% lower peak GPU memory on average. The code can be found at https://github.com/5GYYYYY/SPOTR.

EEG foundation models can learn generalizable representations from large-scale EEG corpora to enable single-backbone transfer across diverse clinical and brain-computer interface tasks. Existing models typically discretize the continuous multi-channel EEG waveform into patches or codebook tokens and train a transformer with masked self-supervision. Recognizing that this discretization fragments continuous brain rhythms and obscures fine-grained temporal dynamics, we present B[FM]$^2$(Brain Foundation Model via Flow Matching), whose inductive bias aligns with the data by pretraining directly on the raw signal using continuous-time flow matching without patches, tokenization, or masking. However, multi-channel EEG signals pose an architectural challenge for flow matching: time is densely sampled and highly autocorrelated (thousands of timepoints), while the electrode axis is short (tens of channels) at distinct scalp positions. To address this time-electrode asymmetry, we introduce SplitUNet, a velocity network that factorizes each block into separate 1D temporal and 1D electrode convolutions and downsamples only along time, preserving electrode topology throughout the hierarchy. B[FM]$^2$ sets a new state of the art on 7 of 9 standard downstream EEG classification tasks, using a pretraining budget of only 36,895 segments ($\approx$ 307h), 1-2 orders of magnitude ($\approx$ 30x) less than required by existing EEG foundation models. Further, it generates synthetic EEGs that two board-certified neurologists cannot distinguish from brain data (Cohen's $κ=$ -0.096). https://jd730.github.io/projects/BFM2

Burst suppression (BS) is a clinically relevant electroencephalographic (EEG) pattern used to monitor sedation depth and brain activity in critically ill patients, particularly during induced coma in Intensive Care Units (ICUs). Automatic burst detection remains challenging because BS patterns vary substantially between patients and annotated datasets are scarce. Recently, EEG Foundation Models (FMs) have shown promise across several downstream EEG applications, but their usefulness for BS detection remains unexplored. We present the first study to evaluate EEG FMs for burst detection in reduced-montage ICU EEG without patient-specific calibration. We compare REVE-base, LUNA-large and LuMamba-Tiny with an adaptive thresholding baseline and a task-specific EEGNet baseline. Additionally, we complement conventional EEG window-based classification with event-based burst detection evaluation. This helps assessing clinically whether burst episodes are correctly detected, reducing the impact of expected annotation variability. The best model, REVE-base, achieved the highest event-based F1-score ($0.868 \pm 0.167$) and reduced burst-per-minute error by 52.1% and 36.2% compared to EEGNet and adaptive thresholding respectively, supporting FMs for scalable EEG monitoring in ICU. Ablation experiments showed that full fine-tuning was the most effective adaptation strategy with respect to frozen-backbone training, two-step fine-tuning, and LoRA-based adaptation, improving event-based F1-score over frozen-backbone training by up to $+0.102$ for LUNA-large. With reduced labeled datasets, pretrained REVE-base outperformed random initialization by $+0.723$ event-based F1 points at 25% of the cohort, demonstrating the benefit of pretraining FM representations when adapted to burst detection with limited labeled data.

Continuous cardiac monitoring in wearable devices demands classifiers that are simultaneously accurate, energy-efficient, and deployable on resource-constrained hardware. While deep neural network approaches have demonstrated high classification accuracy for electrocardiogram (ECG) arrhythmia detection, their substantial parameter counts and reliance on multiply-accumulate-intensive operations make them impractical for low-cost edge platforms. In this work, we propose ECG-LDC, a hardware-software co-design framework that adapts Low-Dimensional Computing (LDC) for real-time ECG arrhythmia classification. ECG-LDC employs a dual-encoder architecture with dedicated value and feature codebooks to independently encode morphological waveform features and RR-interval temporal features, enabling effective capture of both intra-beat and inter-beat cardiac dynamics. The framework encompasses data preprocessing, model training, and a hardware accelerator architecture prototyped on the Pynq-Z2 platform. Implemented using binary representations and XOR/XNOR-based operations, ECG-LDC achieves $97.18\%$ accuracy with a memory footprint of only $3.86\ \text{kB}$. ECG-LDC sacrifices approximately $1.8\%$ accuracy versus SOTA TinyML classifiers but achieves $11$~$570\times$ reduction in memory usage; among FPGA-based five-class arrhythmia classifiers, it delivers the highest accuracy with up to $2.4\times$ fewer LUTs and zero DSP block utilization, affirming its suitability for real-time arrhythmia detection on resource-constrained wearable platforms.

A central challenge in EEG authentication is that models are typically tied to the acquisition settings in which they are trained. In particular, variations in headset hardware, channel layout, and signal duration create heterogeneous recordings that existing models are not designed to handle, causing each new headset or dataset to be treated as a separate model-development problem. This fragmentation limits multi-dataset learning, hinders knowledge transfer, and reduces model reusability. To address this limitation, we present NeuroShield, a reusable foundation model for EEG authentication that learns identity-discriminative embeddings from variable-channel and variable-length EEG recordings through a dual-stage transformer architecture. We pretrain NeuroShield on three public EEG datasets comprising 15{,}762 subjects and 28{,}116 sessions, and evaluate transfer on two unseen downstream datasets. Our evaluations show that, after fine-tuning, NeuroShield reduces equal error rate by 0.44--8.06 percentage points relative to the state of the art. NeuroShield further generalizes to segments longer than those seen during training and operates across channel layouts not encountered during pretraining. These results establish NeuroShield as a reusable and adaptable EEG identity encoder across heterogeneous recording settings. We release NeuroShield as open source to support reproducibility and community adoption.

EEG foundation-model releases are usually audited one endpoint at a time: raw-reconstruction, membership inference, identity linkage, or DP-SGD on the downstream head. We audit the same released embeddings under all four endpoints jointly, on BIOT, LaBraM, and EEGPT, and show that each single-endpoint audit clears releases that still leak spectral attributes. The decisive evidence is a cross-encoder transfer audit: a single ridge attribute decoder learned from one frozen encoder transfers, via a fitted linear bridge, to held-out-subject test splits of every other encoder, with subject-disjoint matched-control 95% CI lower bound at least 0.081 across all six BIOT/LaBraM/EEGPT directions. We prove a sufficient condition: two encoders sharing a nontrivial attribute-coordinate projector overlap beta admit a chained ridge bridge attacker with centered-gain lower bound sqrt(beta/(1+tau^2)) - eps_br - rho_0, and back-solve beta in [0.008, 0.198]. To turn the joint audit into a deployment-readable decision rule we introduce an audit-endpoint disagreement score (AEDS), prove sufficient conditions for its positivity, and bootstrap-calibrate it per cell; AEDS is positive in all eight matched-CI cells (BIOT/LaBraM/EEGPT on EEGMMI; LaBraM on Sleep-EDF, 54-channel LIMO, CHB-MIT pediatric scalp EEG) with p<0.001, while a head-level Carlini LiRA membership audit reaches AUC only 0.50-0.70. Standard defenses fail under audit: a Wiener-style noise-aware adaptive attacker, the LiRA audit, and DP-SGD at every utility-preserving epsilon in {4,8} leave the attribute channel essentially unchanged. The contribution is an audit framework that turns scattered single-endpoint defenses into a joint release decision, supported by a cross-encoder bridge theorem and adaptive-attacker, LiRA, and DP-SGD baselines; the audit licenses release-blocking, not raw-waveform exfiltration or held-out-subject identity recovery.

Foundation models for wearable biosignals have matched or exceeded supervised specialists across a range of clinical tasks, yet all rely on modalities that require deliberate user action--wearing a device or visiting a sleep lab. We introduce BCG-FM, the first foundation model for ambient mechanical biosignals. A piezoelectric sensor embedded in the bed surface records ballistocardiography (BCG) each night without user effort; we pretrain BCG-FM with participant-level contrastive learning and using a total of 2.75 million hours of nightly recordings from 145,985 individuals, the largest raw-waveform biosignal pretraining corpus to date. Frozen BCG-FM embeddings achieve 3.26-year MAE on biological-age estimation (the lowest reported for any ambient, contactless modality) and yield clinically relevant discrimination across 15 self-reported health conditions and three independent external cohorts. Pretrained representations from only 500 labeled participants outperform a fully supervised baseline trained on 3,372, and representation quality scales log-linearly with contrastive batch size. These results establish ambient, longitudinal mechanical biosignals as a viable modality for health foundation models.

Data samples used for training often differ from those encountered during fine-tuning and deployment, and while ML models show promise, their performance remains limited when only small annotated datasets are available. Performance often degrades under distribution shifts caused by diverse sensors, populations, and application settings. Although pre-training helps, models frequently encounter out-of-distribution (OOD) data in real-world settings, leading to reduced robustness. Existing adaptation methods usually assume fixed distribution shifts and struggle when multiple types or severities occur. In particular, they overlook shift severity, for example treating adaptation to a large familiar dataset the same as adaptation to a small dataset with a new task, which limits generalisation. To address this, we propose ADAPTOOD, a novel framework that leverages data uncertainty to quantify distribution shift severity and guide fine-tuning for time series. This uncertainty measures how strongly samples from the target deployment distribution deviate from the pre-training distribution, providing a direct signal of OOD severity. Our framework combines this uncertainty with low-rank model updates and adaptive hyperparameter optimisation to improve adaptation. We show that ADAPTOOD achieves up to 7% higher accuracy and 12.9% higher precision than existing methods in OOD tasks, maintaining strong performance as distribution shift severity increases.

Electroencephalography (EEG) supports a variety of brain-computer interface (BCI) tasks ranging from brain-state monitoring to human-LLM interactions. EEG foundation models are emerging, but evaluation remains fragmented due to heterogeneous datasets and nconsistent task protocols. Here, we introduce OmniEEG-Bench, a unified benchmark and downstream task roadmap for EEG foundation models (FMs). It organizes evaluation of EEG FMs into six task families spanning (i) signal reliability, (ii) biometrics and disease, (iii) consciousness and state, (iv) cognition and emotion, (v) naturalistic stimulus decoding, and (vi) motor and interaction, introducing a new generation of tasks not systematically benchmarked in prior EEG FM work. OmniEEG-Bench standardizes model deployment, task definitions, and metrics through a task-card specification, and unifies 54 EEG datasets with consistent evaluation protocols. We benchmark 10 representative EEG foundation models and report a leaderboard that covers diverse evaluation settings. Both pretraining dataset diversity and model size are significantly associated with better average ranks across datasets, revealing scaling-law behavior in EEG foundation models (Figure 1). These results suggest that scaling EEG foundation models requires not only larger architectures but also broader and more diverse pretraining data. The benchmark code is available at https://github.com/ncclab-sustech/omni-eegbench.git.

Electrocardiography (ECG) is a cornerstone of cardiac assessment, making the learning of informative ECG representations fundamental to tasks ranging from disease diagnosis to clinical report generation. However, existing methods operate almost exclusively in the observable ECG signal space. In practice, the standard twelve-lead ECG represents multiple projections of the same underlying cardiac electrical activity from different spatial orientations. Therefore, representation learning in the ECG space inevitably introduces substantial redundancy, which may lead to spurious correlations and increased risk of overfitting. To address this and motivated by the Frank vectorcardiogram (VCG) model, we propose learning a unified latent representation of cardiac electrical activity directly in the VCG space. We introduce LVCG, the first general self-supervised representation learning framework designed to operate in this physically grounded latent space. By learning view-invariant latent VCG representations rather than lead-specific artifacts, VCG minimizes redundancy and improves generalization. LVCG generally outperforms ECG-space baselines across tasks, demonstrating enhanced robustness and generalization, especially in domain shift settings.

Evaluating foundation models under appropriate adaptation settings is essential for understanding the quality and transferability of the learned representations. Recent EEG foundation models have demonstrated promising transfer capabilities across tasks and datasets, motivating their growing use in neurotechnology and clinical applications. However, these models are typically evaluated under full fine-tuning on well-curated downstream datasets, a setting that does not reflect biomedical domain constraints such as limited labeled data, reduced sensor coverage, or parameter-efficient adaptation. In this work, we propose a multi-dimensional evaluation framework for assessing EEG models under realistic low-resource conditions. Empirical analysis of both supervised EEG models and recent EEG foundation models, including LaBraM, CSBrain, and CBraMod, across 6 different datasets is performed under the proposed multi-dimensional evaluation framework. We find that EEG foundation models consistently provide performance gains on long-context tasks such as sleep stage prediction and mental health state classification. In contrast, for short-window Brain Computer Interface style tasks, supervised models achieve comparable despite having substantially fewer parameters. Additional analyses demonstrate that current foundation models provide limited robustness to short-window tasks and channel constrained settings. Together, these findings motivate the use of multi-dimensional evaluation protocols that characterize model behavior under realistic use constraints.

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.

Electroencephalogram (EEG)-based emotion recognition is an important affective computing task, and recent EEG foundation models provide useful generic representations for downstream adaptation. However, under the fine-tuning setting, three limitations remain prominent: insufficient modeling of multi-scale emotional dynamics, inadequate exploitation of inter-channel functional connectivity, and the limited expressive power of simple linear classification heads. To address these issues, this paper proposes a new EEG emotion recognition method, termed MSCGC-KAN, which introduces a structured task head composed of multi-scale causal graph convolution and Kolmogorov--Arnold feature mapping. Built on a pre-trained CBraMod backbone, MSCGC-KAN enhances downstream adaptation by jointly strengthening multi-scale temporal modeling, learnable inter-channel connectivity modeling, and nonlinear discriminative mapping within a compact task-specific head. This design preserves the representation advantage of the foundation model while making the classifier more sensitive to emotion-related spatiotemporal patterns. Extensive experiments are conducted on the public FACED and SEED-VII datasets. The proposed method achieves a balanced accuracy of 60.66%, a Cohen's Kappa of 0.5525, and a weighted F1-score of 60.40% on FACED, and obtains 33.27%, 0.2223, and 33.64%, respectively, on SEED-VII. Compared with the CBraMod+Linear baseline, the balanced accuracy is improved by 5.91 and 2.03 percentage points on the two datasets, respectively. These results indicate that structured task-head design is an effective way to improve EEG emotion recognition when fine-tuning pre-trained EEG models.

EEG foundation models, pre-trained on large-scale unlabelled EEG data, have emerged as a promising direction towards learning generalizable EEG representations. Despite showing positive results in data-rich regimes, they often fail to outperform significantly smaller supervised models in low-resource settings compared to fully supervised models. We provide a mechanistic account of this shortcoming, attributing it to a fundamental mismatch between reconstruction-based pretext tasks and the idiosyncratic spectral structure of EEG signals, which decompose into distinct high-power aperiodic and low-power oscillatory components. Using controlled, synthetically-generated EEG inputs, we demonstrate that EEG foundation model embeddings are biased to capture the aperiodic components of the EEG signal while under-representing oscillatory components, particularly at higher frequencies. Additionally, linear probe evaluations on real-world BCI datasets further reveal that embeddings encode subject identity more strongly than task-relevant information, thereby reinforcing the low-frequency and aperiodic component bias in foundation model embeddings trained primarily on reconstruction based objectives. Together, these findings elucidate a failure mode in reconstruction based EEG foundation models and motivate future work to incorporate auxiliary losses explicitly targeting high-frequency oscillatory structure as a path toward more capable and generalizable EEG representations.

Electrocardiography (ECG) is central to cardiovascular care, but conventional AI models are often restricted to common arrhythmias and may generalize poorly across populations or clinically subtle diseases. We developed ECG Contrastive Language-Image Pre-training (ECGCLIP), a signal-language contrastive learning framework that aligns ECG waveforms with expert diagnostic reports. ECGCLIP was pre-trained on 2,837,962 ECG studies from 1,324,856 patients and evaluated on a held-out internal test set plus nine independent external cohorts comprising about 1.5 million ECGs. Evaluation covered 89 downstream tasks, including 45 ECG diagnoses, 39 echocardiographic targets, and 5 rare cardiac diseases, using PRAUC as the primary metric. ECGCLIP consistently improved performance over random initialization and Merl-R18 baselines. On the internal test set, ECGCLIP-R34 achieved strong performance for atrial fibrillation (PRAUC 0.900) and ST-segment elevation myocardial infarction (PRAUC 0.383), with robust generalization across all external cohorts. It also improved low-prevalence and diagnostically elusive diseases, including Ebstein anomaly, constrictive pericarditis, dextrocardia, and cardiac amyloidosis, with internal PRAUC values of 0.253, 0.175, 0.121, and 0.201, respectively. ECGCLIP was data efficient, matching or exceeding full-dataset baseline performance with only 10% of training data. Feature visualization and saliency analysis suggested clinically meaningful representations aligned with established electrocardiographic criteria. These findings indicate that large-scale ECG-report contrastive pre-training can expand routine ECG interpretation beyond common arrhythmias toward broad cardiovascular assessment and opportunistic screening of echocardiographic and rare conditions.

A central challenge in electroencephalography (EEG) foundation modeling is learning transferable representations across recordings with diverse tasks, montages, references, and spectral characteristics. Existing masked modeling approaches often rely on broadband continuous patches or a single discrete representation, which may underrepresent frequency-specific activity. This paper proposes BandVQ, a band-wise vector-quantized EEG foundation model that decomposes EEG into delta, theta, alpha, beta, and gamma bands, trains an independent VQ-VAE tokenizer for each band, and pretrains a shared Transformer encoder on the resulting discrete VQ code indices. The encoder uses masked code tokens, quantized absolute log-power tokens, channel and temporal embeddings, and metadata prefix tokens representing reference, band, task family, and phase. Region-based masking is also introduced to reduce the trivial reconstruction of spatially adjacent electrodes. The model is pretrained on 71 public EEG corpora comprising over 9,200 subjects and 357,000 single-channel hours and evaluated on six subject-independent classification datasets. Under the current evaluation setting, the proposed model achieves strong transfer performance, with the highest reported results on three cognitive tasks and competitive performance on three motor imagery tasks.

Assessing cognitive load continuously and at low latency would help adaptive human-computer interaction, but it remains hard because labeled data are scarce and models generalize poorly across subjects. Recent ECG foundation models, pre-trained on millions of clinical diagnostic ECG recordings, yet they do not apply directly to wearable devices when the sensor configuration and the task both differ. We present CogAdapt, a framework that adapts a clinical ECG foundation model to wearable cognitive load assessment. CogAdapt has two parts. LeadBridge is a learnable adapter that maps 3-lead wearable signals to a 12-lead-compatible representation. ProFine is a progressive fine-tuning strategy that unfreezes encoder layers in stages while limiting representational drift in the pre-trained model. On two public datasets (CLARE and CL-Drive) under leave-one-subject-out cross-validation, CogAdapt reaches macro-F1 of 0.626 and 0.768, improving over from-scratch baselines by 11.2 and 16.1 percentage points. The results show that a clinical ECG pretraining can support subject-independent cognitive load assessment from wearable sensors.