Abstract
Accurate automated interpretation of electrocardio- grams (ECGs) is essential for early detection of cardiac condi- tions such as myocardial infarction and rhythm abnormalities. However, many high-performing deep learning models remain difficult to deploy in clinical settings due to limited transparency and lack of reliability validation. In this work, we present X- Beat, an explainable and reliability-aware benchmark framework for ECG image classification designed to support trustworthy AI systems in healthcare. The proposed framework combines transfer learning with post-hoc explainability and systematic reliability evaluation across four cardiac classes: Abnormal Heartbeat, History of Myocardial Infarction, Myocardial In- farction, and Normal Heartbeat. Multiple ImageNet-pretrained CNN backbones, including EfficientNet-B0, ResNet-50, DenseNet- 121, and MobileNetV3-Large, are evaluated under a unified training protocol. Beyond standard performance metrics, we incorporate Grad-CAM-based visual explanations together with additional analyses, including explanation stability, regional sen- sitivity, and confidence-based reliability assessment, to examine whether model predictions are supported by clinically meaningful evidence. Experimental results show that ResNet-50 achieves the best performance, reaching 91.94% accuracy and a macro F1- score of 0.9098, with strong class separability (AUC up to 0.995). Explanation analyses indicate that the model primarily focuses on waveform-relevant regions, while reliability evaluation suggests that most incorrect predictions occur with lower confidence. Overall, this work provides a structured and reproducible bench- mark for evaluating both predictive performance and explanation reliability in ECG image classification, contributing toward the development of trustworthy and interpretable AI components for clinical decision support systems.
Abstract (translated)
URL
https://arxiv.org/abs/2609.22631
