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This study establishes FOUND-AF, a rigorous benchmarking framework that standardizes the evaluation of nine ECG foundation models for atrial fibrillation detection across diverse datasets. By controlling variables like preprocessing and validation protocols, it identifies ECGFounder as offering superior accuracy with favorable computational efficiency compared to other pretrained encoders. The work provides essential reproducibility standards for deploying compact AI models in clinical cardiac monitoring settings.
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FOUND-AF: Benchmarking ECG Foundation Models for Atrial Fibrillation Detection

arXiv3 min read

arXiv:2608.03597v1 Announce Type: cross Abstract: 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.

Abstract: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.

Artificial Intelligence (cs.AI); Machine Learning (cs.LG)

arXiv:2608.03597 [cs.AI]

(or arXiv:2608.03597v1 [cs.AI] for this version)

https://doi.org/10.48550/arXiv.2608.03597 Focus to learn more arXiv-issued DOI via DataCite (pending registration)

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Full text under the publisher's open licence · 297 words

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