Yong-Yeon Jo

Jong-Hwan Jang, Yong-yeon Jo

Deep learning has enabled ECG diagnostic models with strong performance in tasks such as arrhythmia classification and abnormality detection. However, accuracy alone is insufficient for clinical deployment because it does not explain why a specific output was produced, limiting justification, error analysis, and trust. Although ECG XAI has been extensively investigated and steadily improved, practical pipelines and reporting conventions vary across studies, hindering reuse and reproducibility. To address these issues, we present Explainable AI framework for ECG models (ExECG), a Python framework that provides a three-stage pipeline: Wrapper standardizes access across heterogeneous ECG formats and intermediate representations, Explainer unifies diverse XAI methods under a shared execution protocol, and Visualizer supports consistent cross-method comparison within a unified interface. We demonstrate end-to-end usage with concise examples and two case studies, highlighting interoperable and reproducible ECG explainability.

Byeong Tak Lee, Yong-Yeon Jo, Joon-Myoung Kwon

We study scaling convolutional neural networks (CNNs), specifically targeting Residual neural networks (ResNet), for analyzing electrocardiograms (ECGs). Although ECG signals are time-series data, CNN-based models have been shown to outperform other neural networks with different architectures in ECG analysis. However, most previous studies in ECG analysis have overlooked the importance of network scaling optimization, which significantly improves performance. We explored and demonstrated an efficient approach to scale ResNet by examining the effects of crucial parameters, including layer depth, the number of channels, and the convolution kernel size. Through extensive experiments, we found that a shallower network, a larger number of channels, and smaller kernel sizes result in better performance for ECG classifications. The optimal network scale might differ depending on the target task, but our findings provide insight into obtaining more efficient and accurate models with fewer computing resources or less time. In practice, we demonstrate that a narrower search space based on our findings leads to higher performance.

Byeong Tak Lee, Joon-myoung Kwon, Yong-Yeon Jo

Domain generalization aim to train models to effectively perform on samples that are unseen and outside of the distribution. Adversarial data augmentation (ADA) is a widely used technique in domain generalization. It enhances the model robustness by including synthetic samples designed to simulate potential unseen scenarios into the training datasets, which is then used to train the model. However, in time series data, traditional ADA approaches often fail to address distribution shifts related to temporal characteristics. To address this limitation, we propose Temporal Adversarial Data Augmentation (TADA) for time series data, which incorporate time warping into ADA. Although time warping is inherently non-differentiable, ADA relies on generating samples through backpropagation. We resolve this issue by leveraging the duality between phase shifts in the frequency domain and time shifts in the time domain, thereby making the process differentiable. Our evaluations across various time series datasets demonstrate that TADA outperforms existing methods for domain generalization. In addition, using distribution visualization, we confirmed that the distribution shifts induced by TADA are clearly different from those induced by ADA, and together, they effectively simulate real-world distribution shifts.

Jong-Hwan Jang, Junho Song, Yong-Yeon Jo

Recognizing the need for explainable AI (XAI) approaches to enable the successful integration of AI-based ECG prediction models (AI-ECG) into clinical practice, we introduce a framework generating \textbf{Co}unter\textbf{F}actual \textbf{E}CGs (i,e., named CoFE) to illustrate how specific features, such as amplitudes and intervals, influence the model's predictive decisions. To demonstrate the applicability of the CoFE, we present two case studies: atrial fibrillation classification and potassium level regression models. The CoFE reveals feature changes in ECG signals that align with the established clinical knowledge. By clarifying both \textbf{where valid features appear} in the ECG and \textbf{how they influence the model's predictions}, we anticipate that our framework will enhance the interpretability of AI-ECG models and support more effective clinical decision-making. Our demonstration video is available at: https://www.youtube.com/watch?v=YoW0bNBPglQ.

Jin Yu, JaeHo Park, TaeJun Park et al.

Leveraging Large Language Models (LLMs) with Retrieval-Augmented Generation (RAG) for analyzing medical data, particularly Electrocardiogram (ECG), offers high accuracy and convenience. However, generating reliable, evidence-based results in specialized fields like healthcare remains a challenge, as RAG alone may not suffice. We propose a Zero-shot ECG diagnosis framework based on RAG for ECG analysis that incorporates expert-curated knowledge to enhance diagnostic accuracy and explainability. Evaluation on the PTB-XL dataset demonstrates the framework's effectiveness, highlighting the value of structured domain expertise in automated ECG interpretation. Our framework is designed to support comprehensive ECG analysis, addressing diverse diagnostic needs with potential applications beyond the tested dataset.

Yong-Yeon Jo, Byeong Tak Lee, Beom Joon Kim et al.

Online Test-Time Adaptation (OTTA) enhances model robustness by updating pre-trained models with unlabeled data during testing. In healthcare, OTTA is vital for real-time tasks like predicting blood pressure from biosignals, which demand continuous adaptation. We introduce a new test-time scenario with streams of unlabeled samples and occasional labeled samples. Our framework combines supervised and self-supervised learning, employing a dual-queue buffer and weighted batch sampling to balance data types. Experiments show improved accuracy and adaptability under real-world conditions.

Junho Song, Jong-Hwan Jang, DongGyun Hong et al.

Electrocardiogram (ECG) diagnosis remains challenging due to limited labeled data and the need to capture subtle yet clinically meaningful variations in rhythm and morphology. We present CREMA (Contrastive Regularized Masked Autoencoder), a foundation model for 12-lead ECGs designed to learn generalizable representations through self-supervised pretraining. CREMA combines generative learning and contrastive regularization via a Contrastive Regularized MAE loss, and employs a Signal Transformer (SiT) architecture to capture both local waveform details and global temporal dependencies. We evaluate CREMA on benchmark datasets and real-world clinical environments, including deployment scenarios with significant distribution shifts. CREMA outperforms supervised baselines and existing self-supervised models in both linear probing and fine-tuning evaluations. Notably, it maintains superior performance across diverse clinical domains, such as emergency care, highlighting its robustness under real-world conditions. These results demonstrate that CREMA serves as a scalable and reliable foundation model for ECG diagnostics, supporting downstream applications across heterogeneous and high-risk clinical settings.

Yong-Yeon Jo, Young Sang Choi, Jong-Hwan Jang et al.

The electrocardiogram (ECG) records electrical signals in a non-invasive way to observe the condition of the heart, typically looking at the heart from 12 different directions. Several types of the cardiac disease are diagnosed by using 12-lead ECGs Recently, various wearable devices have enabled immediate access to the ECG without the use of wieldy equipment. However, they only provide ECGs with a couple of leads. This results in an inaccurate diagnosis of cardiac disease due to lacking of required leads. We propose a deep generative model for ECG synthesis from two asynchronous leads to ten leads. It first represents a heart condition referring to two leads, and then generates ten leads based on the represented heart condition. Both the rhythm and amplitude of leads generated resemble those of the original ones, while the technique removes noise and the baseline wander appearing in the original leads. As a data augmentation method, our model improves the classification performance of models compared with models using ECGs with only one or two leads.