# ECG-WM: A Physiology-Informed ECG World Model for Clinical Intervention Simulation

arXiv: https://arxiv.org/abs/2605.17580 · HTML: https://mlsanity.com/paper/2605.17580/

## Key facts

- Cited by 2 papers in the map (data through 14 Oct 2026).
- Placed in Medical imaging and segmentation, one of 14 directions in Diffusion models.
- Builds on 28 of its 46 references that are in the map.
- First posted on arXiv 17 May 2026.

## Placed in

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

## Builds on (most cited first, 28 of 28)

- [Denoising Diffusion Probabilistic Models](https://mlsanity.com/paper/2006.11239/) (2020)
- [GPT-4 Technical Report](https://mlsanity.com/paper/2303.08774/) (2023)
- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [BLIP-2: Bootstrapping Language-Image Pre-training with Frozen Image Encoders and Large Language Models](https://mlsanity.com/paper/2301.12597/) (2023)
- [A Style-Based Generator Architecture for Generative Adversarial Networks](https://mlsanity.com/paper/1812.04948/) (2018)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [Mamba: Linear-Time Sequence Modeling with Selective State Spaces](https://mlsanity.com/paper/2312.00752/) (2023)
- [GPT-4o System Card](https://mlsanity.com/paper/2410.21276/) (2024)
- [World Models](https://mlsanity.com/paper/1803.10122/) (2018)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [ChatGLM: A Family of Large Language Models from GLM-130B to GLM-4 All Tools](https://mlsanity.com/paper/2406.12793/) (2024)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [3D-VLA: A 3D Vision-Language-Action Generative World Model](https://mlsanity.com/paper/2403.09631/) (2024)
- [Ctrl-World: A Controllable Generative World Model for Robot Manipulation](https://mlsanity.com/paper/2510.10125/) (2025)
- [ECG-FM: An Open Electrocardiogram Foundation Model](https://mlsanity.com/paper/2408.05178/) (2024)
- [HERMES: A Unified Self-Driving World Model for Simultaneous 3D Scene Understanding and Generation](https://mlsanity.com/paper/2501.14729/) (2025)
- [EmbodieDreamer: Advancing Real2Sim2Real Transfer for Policy Training via Embodied World Modeling](https://mlsanity.com/paper/2507.05198/) (2025)
- [Synthetic ECG Signal Generation using Probabilistic Diffusion Models](https://mlsanity.com/paper/2303.02475/) (2023)
- [PIN-WM: Learning Physics-INformed World Models for Non-Prehensile Manipulation](https://mlsanity.com/paper/2504.16693/) (2025)
- [TTS-CGAN: A Transformer Time-Series Conditional GAN for Biosignal Data Augmentation](https://mlsanity.com/paper/2206.13676/) (2022)
- [DiffuSETS: 12-lead ECG Generation Conditioned on Clinical Text Reports and Patient-Specific Information](https://mlsanity.com/paper/2501.05932/) (2025)
- [Synthetic ECG Signal Generation Using Generative Neural Networks](https://mlsanity.com/paper/2112.03268/) (2021)
- [SPARTAN: A Sparse Transformer World Model Attending to What Matters](https://mlsanity.com/paper/2411.06890/) (2024)
- [Simulator and Experience Enhanced Diffusion Model for Comprehensive ECG Generation](https://mlsanity.com/paper/2511.09895/) (2025)
- [VCWorld: A Biological World Model for Virtual Cell Simulation](https://mlsanity.com/paper/2512.00306/) (2025)
- [From Generative Engines to Actionable Simulators: The Imperative of Physical Grounding in World Models](https://mlsanity.com/paper/2601.15533/) (2026)
- [ECG-MoE: Mixture-of-Expert Electrocardiogram Foundation Model](https://mlsanity.com/paper/2603.04589/) (2026)

## Built on by (most cited first, 2 of 2)

- [Physiological World Models for Human State Transitions](https://mlsanity.com/paper/2608.15309/) (2026)
- [Capturing Cardiac Cyclicity through Phase-Equivariant Self-Supervised Learning](https://mlsanity.com/paper/2608.21147/) (2026)

## Abstract (arXiv)

Electrocardiogram (ECG)-based models have achieved strong performance in diagnostic tasks, yet they remain limited in modeling how cardiac dynamics evolve under external interventions. In particular, existing approaches focus primarily on static prediction and lack mechanisms to capture ECG variations under different pharmacological conditions. In this work, we propose an ECG World Model for action-conditioned predictive simulation of cardiac electrophysiology. Moving beyond disjoint pipelines, our framework features a principled integration of physiological ordinary differential equation (ODE) priors into latent diffusion dynamics via energy regularization. This structural constraint enables the synthesis of physiologically plausible post-intervention ECG trajectories while effectively mitigating generative hallucinations. Building on this simulation process, we introduce an uncertainty-aware evaluation strategy that leverages the stochasticity of diffusion sampling to characterize both the expected clinical risk and its variability, allowing a more reliable comparative assessment of candidate interventions. We evaluate our method across diverse settings, including controlled drug-response scenarios and real-world clinical records. Beyond standard waveform metrics, experimental results demonstrate improved risk calibration and strong alignment with expert-informed treatment preferences. These results establish our approach as a robust foundation for safe and intervention-aware clinical decision support.