Towards Family-Grouped Hierarchical Federated Learning on Sub-5KB Models: A Feasibility Study of Privacy-Preserving ECG Monitoring for Ultra-Resource-Constrained Wearables

Cardiovascular disease remains the leading cause of death worldwide, and early detection of arrhythmias through continuous ECG monitoring on wearable devices can prevent life-threatening events. Federated Learning (FL) enables privacy-preserving collaborative training by keeping raw ECG data on device, yet standard FL incurs prohibitive communication overhead and standard deep learning models cannot fit on ultra-low-power microcontrollers. We propose Family-Grouped Hierarchical Federated Learning (Family-FL), a three-tier architecture that uses the family as a natural privacy boundary for intra-family aggregation before global synchronization. We further design a hardware-constrained Tiny CNN-LSTM architecture with only 669 parameters, INT8-quantized to occupy merely 4.65KB Flash and 2.95KB RAM, meeting the constraints of STC32G12K128-class microcontrollers. Experiments on the MIT-BIH Arrhythmia Database (mean of 5 independent runs with different seeds) demonstrate that Family-FL reduces communication volume by 76.7% compared to FedAvg while maintaining comparable accuracy. Family-FL-Tiny achieves 91.9 +/- 1.2% accuracy with macro-F1 of 0.483 +/- 0.031, reducing total communication to 0.31% of FedAvg. The model achieves reliable ventricular arrhythmia detection (per-class F1 = 0.80), the most clinically critical abnormality for home-based preliminary screening. These results demonstrate the technical feasibility of privacy-preserving federated learning on ultra-resource-constrained microcontrollers through simulation-based evaluation. We honestly discuss limitations: no hardware deployment, single-dataset validation (MIT-BIH, 47 subjects), reduced rare-class sensitivity, and absence of formal differential privacy guarantees.