# ECG-Agent: On-Device Tool-Calling Agent for ECG Multi-Turn Dialogue

arXiv: https://arxiv.org/abs/2601.20323 · HTML: https://mlsanity.com/paper/2601.20323/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Builds on 22 of its 29 references that are in the map.
- First posted on arXiv 28 Jan 2026.

## Builds on (most cited first, 22 of 22)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Gemini 2.5: Pushing the Frontier with Advanced Reasoning, Multimodality, Long Context, and Next Generation Agentic Capabilities](https://mlsanity.com/paper/2507.06261/) (2025)
- [G-Eval: NLG Evaluation using GPT-4 with Better Human Alignment](https://mlsanity.com/paper/2303.16634/) (2023)
- [ToolLLM: Facilitating Large Language Models to Master 16000+ Real-world APIs](https://mlsanity.com/paper/2307.16789/) (2023)
- [Gorilla: Large Language Model Connected with Massive APIs](https://mlsanity.com/paper/2305.15334/) (2023)
- [8-bit Optimizers via Block-wise Quantization](https://mlsanity.com/paper/2110.02861/) (2021)
- [ChatDoctor: A Medical Chat Model Fine-Tuned on a Large Language Model Meta-AI (LLaMA) Using Medical Domain Knowledge](https://mlsanity.com/paper/2303.14070/) (2023)
- [MMedAgent: Learning to Use Medical Tools with Multi-modal Agent](https://mlsanity.com/paper/2407.02483/) (2024)
- [On-Device Language Models: A Comprehensive Review](https://mlsanity.com/paper/2409.00088/) (2024)
- [A Review on Edge Large Language Models: Design, Execution, and Applications](https://mlsanity.com/paper/2410.11845/) (2024)
- [MedRAX: Medical Reasoning Agent for Chest X-ray](https://mlsanity.com/paper/2502.02673/) (2025)
- [GEM: Empowering MLLM for Grounded ECG Understanding with Time Series and Images](https://mlsanity.com/paper/2503.06073/) (2025)
- [Lead-agnostic Self-supervised Learning for Local and Global Representations of Electrocardiogram](https://mlsanity.com/paper/2203.06889/) (2022)
- [ECG-Chat: A Large ECG-Language Model for Cardiac Disease Diagnosis](https://mlsanity.com/paper/2408.08849/) (2024)
- [ToolDial: Multi-turn Dialogue Generation Method for Tool-Augmented Language Models](https://mlsanity.com/paper/2503.00564/) (2025)
- [Teach Multimodal LLMs to Comprehend Electrocardiographic Images](https://mlsanity.com/paper/2410.19008/) (2024)
- [FactCheXcker: Mitigating Measurement Hallucinations in Chest X-ray Report Generation Models](https://mlsanity.com/paper/2411.18672/) (2024)
- [Time is Not Enough: Time-Frequency based Explanation for Time-Series Black-Box Models](https://mlsanity.com/paper/2408.03636/) (2024)
- [Efficient and Personalized Mobile Health Event Prediction via Small Language Models](https://mlsanity.com/paper/2409.18987/) (2024)
- [Medicine on the Edge: Comparative Performance Analysis of On-Device LLMs for Clinical Reasoning](https://mlsanity.com/paper/2502.08954/) (2025)

## Built on by (most cited first, 4 of 4)

- [CXReasonAgent: Evidence-Grounded Diagnostic Reasoning Agent for Chest X-rays](https://mlsanity.com/paper/2602.23276/) (2026)
- [DeepArrhythmia: Segment-Contextualized ECG Arrhythmia Classification via Selective Evidence Acquisition](https://mlsanity.com/paper/2605.16441/) (2026)
- [ATRIA: Adaptive Traceable ECG Reporting with Iterative Agents](https://mlsanity.com/paper/2606.24392/) (2026)
- [Cardiologent: Multi-Agent Clinical Decision Support for Patient-Level Arrhythmia Assessment, Urgency, and Management](https://mlsanity.com/paper/2607.25340/) (2026)

## Abstract (arXiv)

Recent advances in Multimodal Large Language Models have rapidly expanded to electrocardiograms, focusing on classification, report generation, and single-turn QA tasks. However, these models fall short in real-world scenarios, lacking multi-turn conversational ability, on-device efficiency, and precise understanding of ECG measurements such as the PQRST intervals. To address these limitations, we introduce ECG-Agent, the first LLM-based tool-calling agent for multi-turn ECG dialogue. To facilitate its development and evaluation, we also present ECG-Multi-Turn-Dialogue (ECG-MTD) dataset, a collection of realistic user-assistant multi-turn dialogues for diverse ECG lead configurations. We develop ECG-Agents in various sizes, from on-device capable to larger agents. Experimental results show that ECG-Agents outperform baseline ECG-LLMs in response accuracy. Furthermore, on-device agents achieve comparable performance to larger agents in various evaluations that assess response accuracy, tool-calling ability, and hallucinations, demonstrating their viability for real-world applications.