# ECG-NAT: A Self-supervised Neighborhood Attention Transformer for Multi-lead Electrocardiogram Classification

arXiv: https://arxiv.org/abs/2605.13194 · HTML: https://mlsanity.com/paper/2605.13194/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 16 of its 51 references that are in the map.
- First posted on arXiv 13 May 2026.

## Builds on (most cited first, 16 of 16)

- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Masked Autoencoders Are Scalable Vision Learners](https://mlsanity.com/paper/2111.06377/) (2021)
- [Longformer: The Long-Document Transformer](https://mlsanity.com/paper/2004.05150/) (2020)
- [An Empirical Study of Training Self-Supervised Vision Transformers](https://mlsanity.com/paper/2104.02057/) (2021)
- [Neighborhood Attention Transformer](https://mlsanity.com/paper/2204.07143/) (2022)
- [A Decomposable Attention Model for Natural Language Inference](https://mlsanity.com/paper/1606.01933/) (2016)
- [CLOCS: Contrastive Learning of Cardiac Signals Across Space, Time, and Patients](https://mlsanity.com/paper/2005.13249/) (2020)
- [Guiding Masked Representation Learning to Capture Spatio-Temporal Relationship of Electrocardiogram](https://mlsanity.com/paper/2402.09450/) (2024)
- [Self-supervised representation learning from 12-lead ECG data](https://mlsanity.com/paper/2103.12676/) (2021)
- [Small Data Challenges in Big Data Era: A Survey of Recent Progress on Unsupervised and Semi-Supervised Methods](https://mlsanity.com/paper/1903.11260/) (2019)
- [Self-Supervised Time Series Representation Learning via Cross Reconstruction Transformer](https://mlsanity.com/paper/2205.09928/) (2022)
- [Self-supervised Contrastive Representation Learning for Semi-supervised Time-Series Classification](https://mlsanity.com/paper/2208.06616/) (2022)
- [Lead-agnostic Self-supervised Learning for Local and Global Representations of Electrocardiogram](https://mlsanity.com/paper/2203.06889/) (2022)
- [LSTM-Based ECG Classification for Continuous Monitoring on Personal Wearable Devices](https://mlsanity.com/paper/1812.04818/) (2018)
- [MSW-Transformer: Multi-Scale Shifted Windows Transformer Networks for 12-Lead ECG Classification](https://mlsanity.com/paper/2306.12098/) (2023)

## Abstract (arXiv)

Electrocardiogram (ECG) arrhythmia classification remains challenging due to signal variability, noise, limited labeled data, and the difficulty in achieving both accuracy and efficiency in models. While self-supervised learning reduces label dependency, most methods target either global contextual features or local morphological patterns, but rarely implement hierarchical multi-scale feature extraction. ECG signals require architectures that simultaneously capture fine-grained beat-level morphology and broader rhythm-level dependencies with computational efficiency. To overcome this limitation, this paper proposes the Electrocardiogram Neighborhood Attention Transformer (ECG-NAT), a novel self-supervised learning approach tailored for multi-lead ECG classification. Our two-stage approach begins with generative pretraining, using a masked autoencoder to reconstruct partially masked ECG signals across multiple diverse datasets, enabling the model to learn robust, domain-invariant representations from unlabeled data. This is followed by discriminative fine-tuning with a dual-loss function that combines supervised contrastive and cross-entropy losses, aligning representation learning with label prediction. The hierarchical attention mechanism efficiently captures multi-scale temporal features from localized beat morphology to broader rhythm patterns at low computational cost. ECG-NAT achieves robust performance on benchmark datasets, with 88.1% accuracy using only 1% labeled data, demonstrating strong efficacy in low-resource settings. The framework combines superior classification performance with computational efficiency, making it practical for real-time ECG diagnosis. The code will be made available upon acceptance at: https://github.com/Mahsagazeran/ECG-NAT.