Electrocardiogram Foundation Models

High-fidelity EEG generation is critical for alleviating data scarcity and addressing privacy constraints in large-scale neural modeling. Despite recent progress, most existing approaches formulate EEG generation via discrete denoising objectives, which inadequately reflect the inherently continuous temporal dynamics and spectral structure of neural activity. As a result, these methods often struggle to preserve long-range temporal dependencies and exhibit mismatches in the spectral and temporal structure of the generated signals. In this work, we argue that effective EEG generation requires models that operate directly on the continuous evolution of neural signals. We introduce Just EEG Transformer (JET), a generative framework based on conditional flow matching that models EEG as raw sequences evolving along continuous trajectories. By learning a smooth vector field that transports noise to the EEG data distribution, JET captures temporal continuity and transient dynamics without relying on discretized denoising schemes or domain-specific representations. To ensure that the learned dynamics remain consistent with key properties of EEG signals, we introduce principled constraints that preserve spectral structure, temporal stationarity, and signal-level statistics. Across three large-scale benchmarks, JET consistently achieves state-of-the-art performance, reducing TS-FID by over 40% compared to strong baselines. Extensive analyses show that JET captures key structural properties of neural dynamics, providing a scalable and principled approach to EEG generation. Project page: https://y-research-sbu.github.io/JET/ .

Neuroscientists have recently turned to intracranial brain recording methods, like electrocorticography (ECoG), for human experiments because of the fine spatial and temporal resolution that they afford. Models trained on this data, however, are fundamentally restricted by the patient populations that can receive the implants necessary for recording. We propose using non-invasive fMRI to bridge the gap in training data. Using spoken language representations fine-tuned on fMRI, we build encoding models of ECoG. These representations showed improved prediction performance in ECoG, even though the temporal resolution of fMRI is two orders of magnitude worse. Prediction improved in frequency bands well beyond what is directly measured in fMRI. Next, to test the procedure's generalization ability, we fine-tuned models on fMRI responses that were temporally downsampled by a factor of 2. Despite the loss in resolution, these models were able to predict fMRI and ECoG responses at levels comparable to the original fMRI-tuned models. Finally, we showed that ECoG performance steadily scales with the amount of fMRI-tuning data. Our results show that "slow" data like fMRI can be a valuable resource for building better models of "fast" brain data like ECoG. In the future, integrating across multiple recording methods may further improve performance in other applications, like decoding.

Foundation models pre-trained through masked reconstruction on large-scale EEG data have emerged as a promising paradigm for learning generalizable neural representations across diverse brain-computer interface applications. However, a critical yet overlooked challenge is that EEG encoders must learn representations invariant to incomplete observations-when different masked views of the same signal have minimal overlap, existing methods fail to constrain them to a consistent latent subspace, leading to degraded transferability. To address this, we propose DARE-EEG, a self-supervised foundation model that explicitly enforces the mask-invariance property through dual-aligned representation learning during pre-training. Specifically, we introduce mask alignment that constrains representations from multiple masked views of the same EEG sample via contrastive learning, complementing anchor alignment that aligns masked representations to momentum-updated complete features for semantic stability. Additionally, we propose conv-linear-probing, a parameter-efficient strategy that adapts pre-trained representations to heterogeneous electrode configurations and sampling rates through decoupled spectro-spatial projections. Extensive experiments across diverse EEG benchmarks demonstrate that DARE-EEG consistently achieves state-of-the-art in accuracy performance while maintaining relatively low parameter complexity and superior cross-dataset portability compared to existing methods. Furthermore, DARE-EEG contributes to effectively discovering and utilizing the rich potential representations in EEG.

EEG foundation models (EEG-FMs) have been evaluated predominantly on clean, in-distribution accuracy, leaving their robustness, interpretability and representational quality largely unexamined. This study addresses these gaps by benchmarking six EEG-FMs against a baseline deep learning model across eight datasets. Beyond clean accuracy, we conduct three layers of analysis: (i) Robustness: we apply test-time perturbations including additive noise, random and region-based channel dropout and region-specific noise injection. Our analyses show that no single model dominates all failure modes. The most noise-robust model is among the most fragile under channel dropout and much of the dropout fragility disappears when channels are removed rather than zero-padded. (ii) Interpretability: we present the first application of Attention-Aware Layer-Wise Relevance Propagation (AttnLRP) to EEG-FMs and show that models broadly concentrate relevance on task-appropriate brain regions consistent with known neurophysiology. However, attribution maps remain spatially stable under perturbation while predictions degrade, suggesting that the models attend to the correct brain regions but decode corrupted content. (iii) Expressiveness: With block-wise probing we show that late blocks are repurposed during fine-tuning, while early blocks already hold task-related information. Furthermore, we demonstrate that the poor head-only performance previously attributed to low-quality pre-trained representations is largely explained by pooling and that EEG-FMs possess sufficient representational capacity when their token-level embeddings are preserved. Together, these findings provide the first systematic assessment of robustness, interpretability and expressiveness for EEG-FMs and highlight critical considerations for their development.

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

Electrocardiogram (ECG) foundation models pretrained on typical diagnostic 10-second ECG segments, have demonstrated strong transferability across a range of clinical applications. However, many real-world applications produce recordings that are typically longer, and are varied in duration during inference time. These 10-second models have no built-in way to combine information across time. Extending them to longer horizons introduces two challenges: structural incompatibilities arising from input-length disparities, and semantic challenges that limit meaningful temporal aggregation. We propose a parameter-efficient framework that extends pretrained ECG foundation models to longer and variable-length ECGs without retraining the backbone. Guided by a frozen pretrained 10-second model, we introduce a lightweight plug-in module that extends the model in two complementary ways: (i) structurally compatible long-sequence processing and (ii) semantically informed temporal modeling. Experiments on multiple long-horizon ECG tasks, datasets, and foundation model backbones demonstrate that our method enables robust long-horizon extension from pretrained snapshot models, consistently outperforming sliding-window and pooling-based baselines with strong parameter efficiency.

Foundation models (FMs) promise to extract unified representations that generalize across downstream tasks. They have emerged across fields, including electroencephalography (EEG), but it is less clear how effective they are in this particular field. Published evaluations differ in datasets, in the EEG-specific preprocessing that might influence reported results, and in the reported metrics, frequently obscuring the clinical relevance in EEG. We introduce NeuroAtlas, the largest EEG benchmark to date: 42 datasets and 260k hours covering clinical EEG (epilepsy, sleep medicine, brain age estimation) and brain-computer interfaces, and include multiple datasets per task along with bespoke clinical evaluation metrics. Besides evaluating EEG-FMs with respect to supervised baselines, we present results from generic time-series FMs. We report three findings. First, EEG-specific FMs do not consistently outperform time-series FMs, which have neither EEG-focused architectures nor been pretrained on EEG. Second, standard machine learning metrics are insufficient to assess clinical utility: thus, we thoroughly evaluate more appropriate measures such as the quality of event-level decision-making, hypnogram-derived features, and the brain-age gap in the domains of epilepsy, sleep, and brain age, respectively. Third, model rankings and performance can vary substantially within domains. We conclude that pretrained models perform largely on par, with only narrow advantages for a few, and that current models do not yet deliver on the promise of an out-of-the-box unified EEG model. NeuroAtlas exposes this gap and provides the datasets and metrics for the next generation of unified EEG FMs.

Myocardial infarction (MI) is a leading cause of death, and its adverse outcomes are urgent to predict. Yet ECG-based prognostic models underperform because deep learning requires large, labelled datasets, which are scarce in medicine. Foundation models can learn from unlabelled ECGs via selfsupervision, but medically relevant training strategies remain underexplored. We propose a pretrained artificial intelligence model that combines patient-specific temporal information using contrastive learning with supervised multitask heads, then fine-tunes on post-MI outcome prediction. The proposed model outperformed a model trained from scratch (0.794 vs 0.608 AUC) showing that clinically structured ECG modelling improves classification in limited data regimes.

The analysis of physiological time series, such as electrocardiograms (ECG) and photoplethysmograms (PPG), is persistently hindered by modality and frequency gaps stemming from heterogeneous recording devices. Existing foundation models typically rely on continuous latent spaces, which frequently suffer from severe modality entanglement, lack high-fidelity cross-frequency generative capacity, and impose high computational costs that prohibit edge-device deployment. In this paper, we propose Compact Latent Manifold Translation (CLMT), a highly parameter-efficient (0.09B) unified framework that bridges these gaps through a novel two-stage discrete translation paradigm. First, we introduce a Universal Tokenizer utilizing Hierarchical Residual Vector Quantization (RVQ) to decouple heterogeneous signals into isolated, well-structured discrete latent manifolds, effectively preventing inter-modality interference. Second, a Context-Prompted Latent Translator maps these discrete tokens across modalities by integrating static physiological priors, reframing complex signal synthesis as a pure latent sequence translation task. Extensive evaluations demonstrate that our 0.09B model significantly outperforms massive baselines. In cross-modal PPG-to-ECG synthesis, it resolves temporal phase drift and dramatically improves the clinical R-peak detection F1-score from 0.37 (baseline) to 0.83. Furthermore, in extreme cross-frequency super-resolution (25Hz to 100Hz), it successfully recovers high-frequency diagnostic landmarks, achieving an unprecedented Pearson correlation of 0.9956. By learning a universal discrete language for biological signals with a fraction of the computational footprint, our approach sets a new trajectory for edge-deployable, multi-modal medical foundation models.

Specialized foundation models are beginning to emerge in various medical subdomains, but pretraining methodologies and parametric scaling with the size of the pretraining dataset are rarely assessed systematically and in a like-for-like manner. This work focuses on foundation models for electrocardiography (ECG) data, one of the most widely captured physiological time series world-wide. We present a comprehensive assessment of pretraining methodologies, covering five different contrastive and non-contrastive self-supervised learning objectives for ECG foundation models, and investigate their scaling behavior with pretraining dataset sizes up to 11M input samples, exclusively from publicly available sources. Pretraining strategy has a meaningful and consistent impact on downstream performance, with contrastive predictive coding (slightly ahead of JEPA) yielding the most transferable representations across diverse clinical tasks. Scaling pretraining data continues to yield meaningful improvements up to 11M samples for most objectives. We also compare model architectures across all pretraining methodologies and find evidence for a clear superiority of structured state space models compared to transformers and CNN models. We hypothesize that the strong inductive biases of structured state space models, rather than pretraining scale alone, are the primary driver of effective ECG representation learning, with important implications for future foundation model development in this and potentially other physiological signal domains.

Clinical electroencephalogram (EEG) analysis rests on a hand-crafted feature catalog refined over decades, \emph{e.g.,} band power, connectivity, complexity, and more. Modern EEG foundation models bypass this catalog, learn directly from raw signals via self-supervised pretraining, and match or outperform feature-engineered baselines on most clinical benchmarks. Whether the two representations align is an open question, which we decompose into three sub-questions: \emph{what does the model learn}, \emph{what does the model use}, and \emph{how much can be explained}. We answer them with layer-wise ridge probing, LEACE-style cross-covariance subspace erasure, and a transparent classifier benchmarked against a random-feature baseline. The audit covers three foundation models (CSBrain, CBraMod, LaBraM), five clinical tasks (MDD, Stress, ISRUC-Sleep, TUSL, Siena), and a 6-family 63-feature lexicon. Of the $945$ (model, task, feature) units, $648$ ($68.6\%$) are representation-causal and $199$ ($21.1\%$) are encoded-only. Across tasks, $50$ features qualify as universal candidates with strong support (all three architectures RC) in two or more tasks. Frequency-domain features dominate, but the other five families each contribute substantial causal mass. Confirmed features recover, on average, $79.3\%$ of the foundation model's advantage over the random baseline, with a clean task gradient (MDD $\approx 0.99$ down to Stress $\approx 0.56$): tasks near ceiling are almost fully recovered by the lexicon, while harder tasks leave a non-trivial residual that pinpoints a concrete target for future concept discovery.

Intracranial electrocorticography (ECoG) offers high-signal-to-noise access to cortical activity for brain-computer interfaces, yet limited per-patient data has led most prior work to rely on small, subject-specific decoders that neglect information shared across patients. We investigate whether large pretrained scalp-EEG foundation models (EEG FMs) can be adapted to ECoG, enabling cross-patient learning and competitive decoding performance while calibrating to a held-out patient in 10-30 minutes on a single GPU. We introduce CORTEG, a cross-modality transfer framework that combines a pretrained EEG FM backbone, an electrode-aware KNNSoftFourier spatial adapter, a dual-stream tokenizer for low-frequency and high-gamma activity, and a leave-one-subject-out fine-tuning strategy. We evaluate CORTEG on two challenging regression tasks: public finger trajectory regression (n=9) and private audio envelope regression (n=16). CORTEG matches or exceeds the strongest task-specific baselines on both tasks: it reaches the highest mean correlation among compared methods on the public finger benchmark (gain not statistically significant on n=9 subjects), with larger and statistically significant gains on the audio task and in low-data per-patient calibration. Feature analyses align with neurophysiology, and latent manifolds capture low-dimensional finger-movement structure. CORTEG provides systematic evidence that scalp-EEG pretraining can be repurposed for ECoG decoding, enabling data-efficient intracranial BCIs that can adapt to new patients.

Cardiovascular disease remains the leading cause of global mortality, yet scalable cardiac monitoring is hindered by the gap between diagnostic-rich ECG and ubiquitous wearable PPG. Bridging this gap requires representations that are compact, transferable across modalities and devices, and deployable without task-specific retraining. Here we introduce biosignal fingerprints: compact latent representations of cardiovascular state derived from a cross-modal foundation model, the Multi-modal Masked Autoencoder (M2AE), trained on over 3.4 million paired ECG and PPG signals. M2AE integrates modality-specific encoders with a shared bottleneck and dual decoders, jointly optimized using reconstruction and cross-modal contrastive objectives, yielding generalizable fingerprints that retain intra- and inter-modality features. Like a biometric fingerprint, these representations uniquely encode an individual's cardiovascular state in a modality-agnostic, privacy-preserving form reusable across clinical tasks without exposing raw waveform data or requiring model retraining. Across 7 downstream tasks, spanning cross-modal reconstruction, cardiovascular disease classification, hypertension detection, mortality prediction, and demographic inference, biosignal fingerprints achieve competitive or superior performance compared to leading domain-specialist foundation models in frozen settings, including an AUROC of 0.974 for five-class CVD classification and 0.877 for hypertension detection, with a maximum improvement of 27.7% in AUROC across 5 classification tasks. Critically, strong performance is maintained with only a single modality, enabling deployment in resource-constrained, single-sensor environments typical of real-world wearable monitoring, with direct implications for continuous cardiovascular monitoring across clinical and consumer health settings.

We propose a new class of waveform foundation models that departs from conventional sequence based representations by modeling physiological time series as realizations of latent event processes. Rather than treating signals as collections of local tokens or patches, our approach assumes that clinically meaningful structure arises from temporally extended, interacting events whose boundaries and dynamics are not directly observed. To capture this structure, we introduce a self supervised learning framework that enforces consistency across stochastic segmentations and time frequency projections of the same waveform, encouraging representations that are invariant to signal level perturbations while preserving event level organization. The resulting model combines a segmentation aware encoder with a latent interaction operator that captures dependencies among inferred events, and naturally extends to multimodal settings by aligning modalities through shared event representations. Across a range of physiological benchmarks, including arrhythmia classification, hemodynamic prediction, and waveform retrieval, the proposed method improves performance, robustness, and label efficiency relative to strong sequence based baselines. These results suggest that shifting from signal centric to event centric representations provides a more appropriate inductive bias for modeling physiological dynamics and offers a complementary path to scaling foundation models in healthcare.

Surface electromyography provides a practical way to infer human movement intention from wearable muscle recordings, but models trained under a single acquisition setting often lose reliability when the user, session, electrode layout, or gesture protocol changes. This paper proposes AEMG, a self-supervised learning approach designed to extract reusable neuromuscular representations from diverse EMG sources. Eight public gesture datasets are first transformed into a shared signal format to reduce discrepancies in channel configuration, sensor topology, and recording protocol. Instead of relying on fixed-length sliding windows, AEMG identifies contraction events from energy variations and represents them as compact neuromuscular tokens, while ordered token groups describe the coordinated activity of multiple muscles during motion. A spatially and temporally conditioned Transformer is then used to encode these token sequences, preserving information about electrode position, activation timing, and sequential structure. For pre-training, the model constructs a discrete library of contraction prototypes through vector-quantized reconstruction and further learns contextual dependencies by recovering masked neuromuscular tokens from surrounding observations. Experiments under leave-one-subject-out and low-label adaptation settings show that the learned representation improves robustness to unseen users and reduces the amount of calibration data required for gesture recognition. These findings suggest that event-level token modeling offers a scalable route toward adaptable and data-efficient EMG-based motor-intent understanding.

Sleep foundation models have recently demonstrated strong performance on in-domain polysomnography tasks, including sleep staging, apnea detection, and disease risk prediction. In this work, we investigate whether sleep biosignals can serve as an effective pretraining distribution for learning representations that transfer beyond sleep to adjacent domains. Following sleep foundation models, we perform sleep-only multimodal contrastive pretraining (with a leave-one-out objective) and evaluate transfer to non-sleep EEG and ECG, two well-benchmarked biosignal modalities with heterogeneous datasets and clinically meaningful downstream tasks. Across eight downstream tasks spanning multiple EEG and ECG datasets, sleep pretraining consistently improves performance relative to training from scratch. Moreover, on several tasks, we achieve performance competitive with or surpassing prior specialized state-of-the-art and foundation models.

Transthoracic echocardiography is the reference standard for confirming structural heart disease (SHD), but first-line screening is limited by cost, workflow burden, and specialist availability. We evaluated whether open pretrained electrocardiogram (ECG) foundation models can support echo-confirmed multi-label SHD detection using the public EchoNext Mini-Model benchmark. Six echocardiography-derived abnormalities were targeted: reduced left ventricular ejection fraction, increased left ventricular wall thickness, aortic stenosis, mitral regurgitation, tricuspid regurgitation, and right ventricular systolic dysfunction. Under a common pipeline, we compared engineered ECG features with gradient boosting, end-to-end waveform learning from scratch, and transfer from open ECG foundation models. We then applied in-domain self-supervised adaptation of an ECG foundation model (ECG-FM) on EchoNext waveforms followed by selective supervised fine-tuning, and evaluated trade-offs between discrimination and adaptation cost. Adapted ECG-FM models achieved the best overall performance: peak macro-AUROC 0.8509 and macro-AUPRC 0.4297, while a parameter-efficient operating point preserved AUROC (0.8501) and attained the highest fixed-threshold macro-F1 0.3691. Late fusion with covariates did not improve threshold-independent discrimination, and evaluated LoRA, alternative backbones, and mixture-of-foundations strategies did not surpass the best adapted single-backbone models. These results indicate that for ECG-based case finding and echocardiography triage, combining target-domain self-supervised adaptation with selective supervised updating of a pretrained ECG backbone is the most effective transfer strategy.

The miniaturisation of neural processing units (NPUs) and other low-power accelerators has enabled their integration into microcontroller-scale wearable hardware, supporting near-real-time, offline, and privacy-preserving inference. Yet physiological signal analysis has remained infeasible on such hardware; recent Transformer-based models show state-of-the-art performance but are prohibitively large for resource- and power-constrained hardware and incompatible with $μ$NPUs due to their dynamic attention operations. We introduce PhysioLite, a lightweight, NPU-compatible model architecture and training framework for ECG/EMG signal analysis. Using learnable wavelet filter banks, CPU-offloaded positional encoding, and hardware-aware layer design, PhysioLite reaches performance comparable to state-of-the-art Transformer-based foundation models on ECG and EMG benchmarks, while being <10% of the size ($\sim$370KB with 8-bit quantization). We also profile its component-wise latency and resource consumption on both the MAX78000 and HX6538 WE2 $μ$NPUs, demonstrating its viability for signal analysis on constrained, battery-powered hardware. We release our model(s) and training framework at: https://github.com/j0shmillar/physiolite.

Current deep learning models for electroencephalography (EEG) are often task-specific and depend on large labeled datasets, limiting their adaptability. Although EEG foundation models seek broader applicability, many still rely on predefined multi-channel inputs, electrode-layout assumptions, or model-specific channel handling. To address these limitations, we introduce the Single-Channel Large EEG Model (SingLEM), a self-supervised foundation model whose hybrid convolutional--Transformer encoder maps each channel independently to a reusable representation capturing local and long-range temporal structure. These representations can be used individually or combined through channel-wise feature concatenation. We assembled 71 public EEG datasets comprising approximately 9,200 subjects and 357,000 single-channel hours. For leakage-controlled evaluation, downstream results were obtained with a model pretrained on 68 datasets after excluding the three source datasets underlying the six tasks. A model pretrained on all 71 datasets is provided for general reuse. Across six motor imagery and cognitive tasks under strict leave-one-subject-out (LOSO) evaluation, the leakage-controlled model with concatenated representations and a support vector machine (SVM) classifier achieved the best overall performance among the compared pretrained and classical feature-based methods. Additional classifier and subject-adapted analyses supported the robustness of its representations. These findings support single-channel self-supervised learning as a montage-flexible foundation for reusable EEG feature extraction and electrode-level spatial analysis. The source code and pretrained models are available at https://github.com/ttlabtuat/SingLEM.

Objective: Atrial fibrillation (AF) is the most common cardiac arrhythmia experienced by intensive care unit (ICU) patients and can cause adverse health effects. In this study, we publish a labelled ICU dataset and benchmarks for AF detection. Methods: We compared machine learning models across three data-driven artificial intelligence (AI) approaches: feature-based classifiers, deep learning (DL), and ECG foundation models (FMs). This comparison addresses a critical gap in the literature and aims to pinpoint which AI approach is best for accurate AF detection. Electrocardiograms (ECGs) from a Canadian ICU and the 2021 PhysioNet/Computing in Cardiology Challenge were used to conduct the experiments. Multiple training configurations were tested, ranging from zero-shot inference to transfer learning. Results: On average and across both datasets, ECG FMs performed best, followed by DL, then feature-based classifiers. The model that achieved the top F1 score on our ICU test set was ECG-FM through a transfer learning strategy (F1=0.89). Conclusion: This study demonstrates promising potential for using AI to build an automatic patient monitoring system. Significance: By publishing our labelled ICU dataset (LinkToBeAdded) and performance benchmarks, this work enables the research community to continue advancing the state-of-the-art in AF detection in the ICU. https://physionet.org/content/kingston-icu-af/