Advancing Few-Shot Pediatric Arrhythmia Classification with a Novel Contrastive Loss and Multimodal Learning

Arrhythmias are a major cause of sudden cardiac death in children, making automated rhythm classification from electrocardiograms (ECGs) clinically important. However, pediatric arrhythmia analysis remains challenging because of age-dependent waveform variability, limited data availability, and a pronounced long-tailed class distribution that hinders recognition of rare but clinically important rhythms. To address these issues, we propose a multimodal end-to-end framework that integrates surface ECG and intracardiac electrogram (IEGM) signals for pediatric arrhythmia classification. The model combines dual-branch feature encoders, attention-based cross-modal fusion, and a lightweight Transformer classifier to learn complementary electrophysiological representations. We further introduce an Adaptive Global Class-Aware Contrastive Loss (AGCACL), which incorporates prototype-based alignment, class-frequency reweighting, and globally informed hard-class modulation to improve intra-class compactness and inter-class separability under class imbalance. We evaluate the proposed method on the pediatric subset of the Leipzig Heart Center ECG-Database and establish a reproducible preprocessing pipeline including rhythm-segment construction, denoising, and label grouping. The proposed approach achieves 96.22% Top-1 accuracy and improves macro precision, macro recall, macro F1 score, and macro F2 score by 4.48, 1.17, 6.98, and 7.34 percentage points, respectively, over the strongest baseline. These results indicate improved minority-sensitive classification performance on the current benchmark. However, further validation under subject-independent and multicenter settings is still required before clinical translation.