# LAEF: A Lead-Agnostic ECG Foundation Model Towards Point-of-Care Diagnostics

arXiv: https://arxiv.org/abs/2608.03690 · HTML: https://mlsanity.com/paper/2608.03690/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 22 of its 49 references that are in the map.
- First posted on arXiv 4 Aug 2026.

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

- [Graph Attention Networks](https://mlsanity.com/paper/1710.10903/) (2017)
- [How Powerful are Graph Neural Networks?](https://mlsanity.com/paper/1810.00826/) (2018)
- [HuBERT: Self-Supervised Speech Representation Learning by Masked Prediction of Hidden Units](https://mlsanity.com/paper/2106.07447/) (2021)
- [Similarity of Neural Network Representations Revisited](https://mlsanity.com/paper/1905.00414/) (2019)
- [DropEdge: Towards Deep Graph Convolutional Networks on Node Classification](https://mlsanity.com/paper/1907.10903/) (2019)
- [Contrastive Multi-View Representation Learning on Graphs](https://mlsanity.com/paper/2006.05582/) (2020)
- [Measuring and Relieving the Over-smoothing Problem for Graph Neural Networks from the Topological View](https://mlsanity.com/paper/1909.03211/) (2019)
- [Masked Label Prediction: Unified Message Passing Model for Semi-Supervised Classification](https://mlsanity.com/paper/2009.03509/) (2020)
- [Neural Sheaf Diffusion: A Topological Perspective on Heterophily and Oversmoothing in GNNs](https://mlsanity.com/paper/2202.04579/) (2022)
- [Automatic diagnosis of the 12-lead ECG using a deep neural network](https://mlsanity.com/paper/1904.01949/) (2019)
- [Denoising Diffusion Autoencoders are Unified Self-supervised Learners](https://mlsanity.com/paper/2303.09769/) (2023)
- [ECG-FM: An Open Electrocardiogram Foundation Model](https://mlsanity.com/paper/2408.05178/) (2024)
- [Reliability of CKA as a Similarity Measure in Deep Learning](https://mlsanity.com/paper/2210.16156/) (2022)
- [Guiding Masked Representation Learning to Capture Spatio-Temporal Relationship of Electrocardiogram](https://mlsanity.com/paper/2402.09450/) (2024)
- [Zero-Shot ECG Classification with Multimodal Learning and Test-time Clinical Knowledge Enhancement](https://mlsanity.com/paper/2403.06659/) (2024)
- [Reading Your Heart: Learning ECG Words and Sentences via Pre-training ECG Language Model](https://mlsanity.com/paper/2502.10707/) (2025)
- [Learning General Representation of 12-Lead Electrocardiogram with a Joint-Embedding Predictive Architecture](https://mlsanity.com/paper/2410.08559/) (2024)
- [CLEF: Clinically-Guided Contrastive Learning for Electrocardiogram Foundation Models](https://mlsanity.com/paper/2512.02180/) (2025)
- [Self-Alignment Learning to Improve Myocardial Infarction Detection from Single-Lead ECG](https://mlsanity.com/paper/2509.19397/) (2025)
- [Graph Neural Networks for Topological Feature Extraction in ECG Classification](https://mlsanity.com/paper/2311.04228/) (2023)
- [Self-DANA: A Resource-Efficient Channel-Adaptive Self-Supervised Approach for ECG Foundation Models](https://mlsanity.com/paper/2507.14151/) (2025)
- [Representing and Denoising Wearable ECG Recordings](https://mlsanity.com/paper/2012.00110/) (2020)

## Abstract (arXiv)

Point-of-care cardiac devices such as smartwatches and handheld ECG recorders typically capture 1--2 leads, yet existing ECG foundation models are architecturally constrained to fixed 12-lead inputs, degrading or failing under these reduced configurations. We introduce LAEF (Lead-Agnostic ECG Foundation), a 7M-parameter ECG foundation model that can natively process any lead subset without zero-padding or architectural modification. LAEF represents ECGs as variable-size spatiotemporal graphs with physiologically motivated intra- and inter-lead connectivity, processed by a Graph Attention Network that scales naturally with active lead count.Pre-trained on 9.2M 12-lead ECGs via masked node modelling with stochastic lead sampling, LAEF learns representations robust to lead configuration. Across 18 downstream datasets, LAEF is on par with specialized 12-lead baselines over 12× larger at full lead availability. Under direct point-of-care-oriented diagnostics (1--2 leads), it outperforms all zero-padded alternatives on 17 out of 18 datasets with with a single randomly sampled lead and on 14 out of 18 with 2 leads, with an average AUROC gain of +3.2 points. Representation analysis links this advantage to architectural lead-agnosticism, and a lead-importance study across 164 cardiovascular conditions shows population-level performance is stable across single standard input leads while still recovering established clinically lead-condition associations.