# Transfer Learning in ECG Diagnosis: Is It Effective?

arXiv: https://arxiv.org/abs/2402.02021 · HTML: https://mlsanity.com/paper/2402.02021/

## Key facts

- Cited by 3 papers in the map (data through 7 Oct 2026).
- Builds on 19 of its 68 references that are in the map.
- First posted on arXiv 3 Feb 2024.

## Builds on (most cited first, 19 of 19)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [Very Deep Convolutional Networks for Large-Scale Image Recognition](https://mlsanity.com/paper/1409.1556/) (2014)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [Going Deeper with Convolutions](https://mlsanity.com/paper/1409.4842/) (2014)
- [Learning Phrase Representations using RNN Encoder-Decoder for Statistical Machine Translation](https://mlsanity.com/paper/1406.1078/) (2014)
- [How transferable are features in deep neural networks?](https://mlsanity.com/paper/1411.1792/) (2014)
- [Do Better ImageNet Models Transfer Better?](https://mlsanity.com/paper/1805.08974/) (2018)
- [Bag of Tricks for Image Classification with Convolutional Neural Networks](https://mlsanity.com/paper/1812.01187/) (2018)
- [DeCAF: A Deep Convolutional Activation Feature for Generic Visual Recognition](https://mlsanity.com/paper/1310.1531/) (2013)
- [CNN Features off-the-shelf: an Astounding Baseline for Recognition](https://mlsanity.com/paper/1403.6382/) (2014)
- [Automatic diagnosis of the 12-lead ECG using a deep neural network](https://mlsanity.com/paper/1904.01949/) (2019)
- [Deep Learning for ECG Analysis: Benchmarks and Insights from PTB-XL](https://mlsanity.com/paper/2004.13701/) (2020)
- [LSTM-Based ECG Classification for Continuous Monitoring on Personal Wearable Devices](https://mlsanity.com/paper/1812.04818/) (2018)
- [Icentia11K: An Unsupervised Representation Learning Dataset for Arrhythmia Subtype Discovery](https://mlsanity.com/paper/1910.09570/) (2019)
- [ECG Arrhythmia Classification Using Transfer Learning from 2-Dimensional Deep CNN Features](https://mlsanity.com/paper/1812.04693/) (2018)
- [Quantifying Inherent Randomness in Machine Learning Algorithms](https://mlsanity.com/paper/2206.12353/) (2022)
- [MELEP: A Novel Predictive Measure of Transferability in Multi-Label ECG Diagnosis](https://mlsanity.com/paper/2311.04224/) (2023)

## Built on by (most cited first, 3 of 3)

- [Comparing Deep Neural Network for Multi-Label ECG Diagnosis From Scanned ECG](https://mlsanity.com/paper/2502.14909/) (2025)
- [FoundationalECGNet: A Lightweight Foundational Model for ECG-based Multitask Cardiac Analysis](https://mlsanity.com/paper/2509.08961/) (2025)
- [Revitalizing Medical Time Series with Vision-Informed Retrieval: A Vision-Language Perspective](https://mlsanity.com/paper/2609.34652/) (2026)

## Abstract (arXiv)

The adoption of deep learning in ECG diagnosis is often hindered by the scarcity of large, well-labeled datasets in real-world scenarios, leading to the use of transfer learning to leverage features learned from larger datasets. Yet the prevailing assumption that transfer learning consistently outperforms training from scratch has never been systematically validated. In this study, we conduct the first extensive empirical study on the effectiveness of transfer learning in multi-label ECG classification, by investigating comparing the fine-tuning performance with that of training from scratch, covering a variety of ECG datasets and deep neural networks. We confirm that fine-tuning is the preferable choice for small downstream datasets; however, when the dataset is sufficiently large, training from scratch can achieve comparable performance, albeit requiring a longer training time to catch up. Furthermore, we find that transfer learning exhibits better compatibility with convolutional neural networks than with recurrent neural networks, which are the two most prevalent architectures for time-series ECG applications. Our results underscore the importance of transfer learning in ECG diagnosis, yet depending on the amount of available data, researchers may opt not to use it, considering the non-negligible cost associated with pre-training.