Anomaly Detection in Electrocardiograms: Advancing Clinical Diagnosis Through Self-Supervised Learning

The electrocardiogram (ECG) is an essential tool for diagnosing heart disease, with computer-aided systems improving diagnostic accuracy and reducing healthcare costs. Despite advancements, existing systems often miss rare cardiac anomalies that could be precursors to serious, life-threatening issues or alterations in the cardiac macro/microstructure. We address this gap by focusing on self-supervised anomaly detection (AD), training exclusively on normal ECGs to recognize deviations indicating anomalies. We introduce a novel self-supervised learning framework for ECG AD, utilizing a vast dataset of normal ECGs to autonomously detect and localize cardiac anomalies. It proposes a novel masking and restoration technique alongside a multi-scale cross-attention module, enhancing the model's ability to integrate global and local signal features. The framework emphasizes accurate localization of anomalies within ECG signals, ensuring the method's clinical relevance and reliability. To reduce the impact of individual variability, the approach further incorporates crucial patient-specific information from ECG reports, such as age and gender, thus enabling accurate identification of a broad spectrum of cardiac anomalies, including rare ones. Utilizing an extensive dataset of 478,803 ECG graphic reports from real-world clinical practice, our method has demonstrated exceptional effectiveness in AD across all tested conditions, regardless of their frequency of occurrence, significantly outperforming existing models. It achieved superior performance metrics, including an AUROC of 91.2%, an F1 score of 83.7%, a sensitivity rate of 84.2%, a specificity of 83.0%, and a precision of 75.6% with a fixed recall rate of 90%. It has also demonstrated robust localization capabilities, with an AUROC of 76.5% and a Dice coefficient of 65.3% for anomaly localization.