# Simulator and Experience Enhanced Diffusion Model for Comprehensive ECG Generation

arXiv: https://arxiv.org/abs/2511.09895 · HTML: https://mlsanity.com/paper/2511.09895/

## Key facts

- Cited by 8 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 33 of its 64 references that are in the map.
- First posted on arXiv 13 Nov 2025.

## Placed in

- Diffusion models / [Medical imaging and segmentation](https://mlsanity.com/diffusion/medical-imaging-and-segmentation/)

## Builds on (most cited first, 30 of 33)

- [Attention Is All You Need](https://mlsanity.com/paper/1706.03762/) (2017)
- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [U-Net: Convolutional Networks for Biomedical Image Segmentation](https://mlsanity.com/paper/1505.04597/) (2015)
- [High-Resolution Image Synthesis with Latent Diffusion Models](https://mlsanity.com/paper/2112.10752/) (2021)
- [Retrieval-Augmented Generation for Knowledge-Intensive NLP Tasks](https://mlsanity.com/paper/2005.11401/) (2020)
- [Score-Based Generative Modeling through Stochastic Differential Equations](https://mlsanity.com/paper/2011.13456/) (2020)
- [Deep Unsupervised Learning using Nonequilibrium Thermodynamics](https://mlsanity.com/paper/1503.03585/) (2015)
- [Neural Ordinary Differential Equations](https://mlsanity.com/paper/1806.07366/) (2018)
- [Improved Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2102.09672/) (2021)
- [Playing Atari with Deep Reinforcement Learning](https://mlsanity.com/paper/1312.5602/) (2013)
- [FiLM: Visual Reasoning with a General Conditioning Layer](https://mlsanity.com/paper/1709.07871/) (2017)
- [CCNet: Criss-Cross Attention for Semantic Segmentation](https://mlsanity.com/paper/1811.11721/) (2018)
- [Universal Differential Equations for Scientific Machine Learning](https://mlsanity.com/paper/2001.04385/) (2020)
- [Learning from Simulated and Unsupervised Images through Adversarial Training](https://mlsanity.com/paper/1612.07828/) (2016)
- [Efficient Diffusion Training via Min-SNR Weighting Strategy](https://mlsanity.com/paper/2303.09556/) (2023)
- [ECG Heartbeat Classification: A Deep Transferable Representation](https://mlsanity.com/paper/1805.00794/) (2018)
- [Cardiologist-Level Arrhythmia Detection with Convolutional Neural Networks](https://mlsanity.com/paper/1707.01836/) (2017)
- [Vision-Language Gradient Descent-driven All-in-One Deep Unfolding Networks](https://mlsanity.com/paper/2503.16930/) (2025)
- [Diffusion-based Conditional ECG Generation with Structured State Space Models](https://mlsanity.com/paper/2301.08227/) (2023)
- [SimGANs: Simulator-Based Generative Adversarial Networks for ECG Synthesis to Improve Deep ECG Classification](https://mlsanity.com/paper/2006.15353/) (2020)
- [DiffuSETS: 12-lead ECG Generation Conditioned on Clinical Text Reports and Patient-Specific Information](https://mlsanity.com/paper/2501.05932/) (2025)
- [BrainODE: Dynamic Brain Signal Analysis via Graph-Aided Neural Ordinary Differential Equations](https://mlsanity.com/paper/2405.00077/) (2024)
- [AerialVG: A Challenging Benchmark for Aerial Visual Grounding by Exploring Positional Relations](https://mlsanity.com/paper/2504.07836/) (2025)
- [DiffECG: A Versatile Probabilistic Diffusion Model for ECG Signals Synthesis](https://mlsanity.com/paper/2306.01875/) (2023)
- [Experience Retrieval-Augmentation with Electronic Health Records Enables Accurate Discharge QA](https://mlsanity.com/paper/2503.17933/) (2025)
- [Explorations and Lessons Learned in Building an Autonomous Formula SAE Car from Simulations](https://mlsanity.com/paper/1905.05940/) (2019)
- [Arrhythmia Classification using CGAN-augmented ECG Signals](https://mlsanity.com/paper/2202.00569/) (2022)
- [PPG-Distill: Efficient Photoplethysmography Signals Analysis via Foundation Model Distillation](https://mlsanity.com/paper/2509.19215/) (2025)
- [Conditional Neural ODE for Longitudinal Parkinson's Disease Progression Forecasting](https://mlsanity.com/paper/2511.04789/) (2025)
- [FlowECG: Using Flow Matching to Create a More Efficient ECG Signal Generator](https://mlsanity.com/paper/2509.10491/) (2025)

## Built on by (most cited first, 8 of 8)

- [ECG-R1: Protocol-Guided and Modality-Agnostic MLLM for Reliable ECG Interpretation](https://mlsanity.com/paper/2602.04279/) (2026)
- [Do LLMs Know What Is Private Internally? Probing and Steering Contextual Privacy Norms in Large Language Model Representations](https://mlsanity.com/paper/2604.00209/) (2026)
- [ECG-WM: A Physiology-Informed ECG World Model for Clinical Intervention Simulation](https://mlsanity.com/paper/2605.17580/) (2026)
- [EHRBench: An Automated and Reliable EHR-based Benchmark for Clinical Decision Making with LLMs](https://mlsanity.com/paper/2605.30637/) (2026)
- [ECGFlowCMR: Pretraining with ECG-Generated Cine CMR Helps Cardiac Disease Classification and Phenotype Prediction](https://mlsanity.com/paper/2601.20904/) (2026)
- [Exposing Vulnerabilities in Explanation for Time Series Classifiers via Dual-Target Attacks](https://mlsanity.com/paper/2602.02763/) (2026)
- [Speaking Numbers to LLMs: Multi-Wavelet Number Embeddings for Time Series Forecasting](https://mlsanity.com/paper/2606.26487/) (2026)
- [Coarse-to-Fine Multi-Resolution Diffusion Models for Trajectory Generation in Urban Systems](https://mlsanity.com/paper/2608.14570/) (2026)

## Abstract (arXiv)

Cardiovascular disease (CVD) is a leading cause of mortality worldwide. Electrocardiograms (ECGs) are the most widely used non-invasive tool for cardiac assessment, yet large, well-annotated ECG corpora are scarce due to cost, privacy, and workflow constraints. Generating ECGs can be beneficial for the mechanistic understanding of cardiac electrical activity, enable the construction of large, heterogeneous, and unbiased datasets, and facilitate privacy-preserving data sharing. Generating realistic ECG signals from clinical context is important yet underexplored. Recent work has leveraged diffusion models for text-to-ECG generation, but two challenges remain: (i) existing methods often overlook the physiological simulator knowledge of cardiac activity; and (ii) they ignore broader, experience-based clinical knowledge grounded in real-world practice. To address these gaps, we propose SE-Diff, a novel physiological simulator and experience enhanced diffusion model for comprehensive ECG generation. SE-Diff integrates a lightweight ordinary differential equation (ODE)-based ECG simulator into the diffusion process via a beat decoder and simulator-consistent constraints, injecting mechanistic priors that promote physiologically plausible waveforms. In parallel, we design an LLM-powered experience retrieval-augmented strategy to inject clinical knowledge, providing more guidance for ECG generation. Extensive experiments on real-world ECG datasets demonstrate that SE-Diff improves both signal fidelity and text-ECG semantic alignment over baselines, proving its superiority for text-to-ECG generation. We further show that the simulator-based and experience-based knowledge also benefit downstream ECG classification.