Investigating ECG Diagnosis with Ambiguous Labels using Partial Label Learning

Label ambiguity is an inherent problem in real-world electrocardiogram (ECG) diagnosis, arising from overlapping conditions and diagnostic disagreement. However, current ECG models are trained under the assumption of clean and non-ambiguous annotations, which limits both the development and the meaningful evaluation of models under real-world conditions. Although Partial Label Learning (PLL) frameworks are designed to learn from ambiguous labels, their effectiveness in medical time-series domains, ECG in particular, remains largely unexplored. In this work, we present the first systematic study of PLL methods for ECG diagnosis. We adapt nine PLL algorithms to multi-label ECG diagnosis and evaluate them using a diverse set of clinically motivated ambiguity generation strategies, capturing both unstructured (e.g., random) and structured ambiguities (e.g., cardiologist-derived similarities, treatment relationships, and diagnostic taxonomies). Our experiments on the PTB-XL and Chapman datasets demonstrate that PLL methods vary substantially in their robustness to different types and degrees of ambiguity. Through extensive analysis, we identify key limitations of current PLL approaches in clinical settings and outline future directions for developing robust and clinically aligned ambiguity-aware learning frameworks for ECG diagnosis.

Dynamic Prototype Rehearsal for Continual Learning in ECG Arrhythmia Detection

Continual Learning (CL) methods aim to learn from a sequence of tasks while avoiding the challenge of forgetting previous knowledge. We present DREAM-CL, a novel CL method for ECG arrhythmia detection that introduces dynamic prototype rehearsal memory. DREAM-CL selects representative prototypes by clustering data based on learning behavior during each training session. Within each cluster, we apply a smooth sorting operation that ranks samples by training difficulty, compressing extreme values and removing outliers. The more challenging samples are then chosen as prototypes for the rehearsal memory, ensuring effective knowledge retention across sessions. We evaluate our method on time-incremental, class-incremental, and lead-incremental scenarios using two widely used ECG arrhythmia datasets, Chapman and PTB-XL. The results demonstrate that DREAM-CL outperforms the state-of-the-art in CL for ECG arrhythmia detection. Detailed ablation and sensitivity studies are performed to validate the different design choices of our method.

In-Distribution and Out-of-Distribution Self-supervised ECG Representation Learning for Arrhythmia Detection

This paper presents a systematic investigation into the effectiveness of Self-Supervised Learning (SSL) methods for Electrocardiogram (ECG) arrhythmia detection. We begin by conducting a novel distribution analysis on three popular ECG-based arrhythmia datasets: PTB-XL, Chapman, and Ribeiro. To the best of our knowledge, our study is the first to quantify these distributions in this area. We then perform a comprehensive set of experiments using different augmentations and parameters to evaluate the effectiveness of various SSL methods, namely SimCRL, BYOL, and SwAV, for ECG representation learning, where we observe the best performance achieved by SwAV. Furthermore, our analysis shows that SSL methods achieve highly competitive results to those achieved by supervised state-of-the-art methods. To further assess the performance of these methods on both In-Distribution (ID) and Out-of-Distribution (OOD) ECG data, we conduct cross-dataset training and testing experiments. Our comprehensive experiments show almost identical results when comparing ID and OOD schemes, indicating that SSL techniques can learn highly effective representations that generalize well across different OOD datasets. This finding can have major implications for ECG-based arrhythmia detection. Lastly, to further analyze our results, we perform detailed per-disease studies on the performance of the SSL methods on the three datasets.