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arXiv · 2601.07124

Towards Automated Diagnosis of Inherited Arrhythmias: Combined Arrhythmia Classification Using Lead-Aware Spatial Attention Networks

Sophie Sigfstead·River Jiang·Brianna Davies·Zachary W. M. Laksman·Julia Cadrin-Tourigny·Rafik Tadros·Habib Khan·Joseph Atallah·Christian Steinberg·Shubhayan Sanatani·Mario Talajic·Rahul Krishnan·Andrew D. Krahn·Christopher C. Cheung
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Abstract

Arrhythmogenic right ventricular cardiomyopathy (ARVC) and long QT syndrome (LQTS) are inherited arrhythmia syndromes associated with sudden cardiac death. Deep learning shows promise for ECG interpretation, but multi-class inherited arrhythmia classification with clinically grounded interpretability remains underdeveloped. Our objective was to develop and validate a lead-aware deep learning framework for multi-class (ARVC vs LQTS vs control) and binary inherited arrhythmia classification, and to determine optimal strategies for integrating ECG foundation models within arrhythmia screening tools. We assembled a 13-center Canadian cohort (645 patients; 1,344 ECGs). We evaluated four ECG foundation models using three transfer learning approaches: linear probing, fine-tuning, and combined strategies. We developed lead-aware spatial attention networks (LASAN) and assessed integration strategies combining LASAN with foundation models. Performance was compared against the established foundation model baselines. Lead-group masking quantified disease-specific lead dependence. Fine-tuning outperformed linear probing and combined strategies across all foundation models (mean macro-AUROC 0.904 vs 0.825). The best lead-aware integrations achieved near-ceiling performance (HuBERT-ECG hybrid: macro-AUROC 0.990; ARVC vs control AUROC 0.999; LQTS vs control AUROC 0.994). Lead masking demonstrated physiologic plausibility: V1-V3 were most critical for ARVC detection (4.54% AUROC reduction), while lateral leads were preferentially important for LQTS (2.60% drop). Lead-aware architectures achieved state-of-the-art performance for inherited arrhythmia classification, outperforming all existing published models on both binary and multi-class tasks while demonstrating clinically aligned lead dependence. These findings support potential utility for automated ECG screening pending validation.

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Sophie Sigfstead, River Jiang, Brianna Davies, Zachary W. M. Laksman, Julia Cadrin-Tourigny, Rafik Tadros, Habib Khan, Joseph Atallah, Christian Steinberg, Shubhayan Sanatani, Mario Talajic, Rahul Krishnan, Andrew D. Krahn, Christopher C. Cheung. 2026-01-12. Towards Automated Diagnosis of Inherited Arrhythmias: Combined Arrhythmia Classification Using Lead-Aware Spatial Attention Networks. https://arxiv.org/abs/2601.07124

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