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ECGJev reframes 12-lead ECG interpretation as multiple-choice option scoring. Frozen waveform and spectrogram encoders feed 16 question-conditioned ECG tokens into a 0.8B decision decoder (LoRA), which scores every answer option in one forward pass instead of generating free text.
Clinical interpretation of a 12-lead electrocardiogram (ECG) often requires answering targeted diagnostic questions with clear, quantifiable decisions. We introduce ECGJev, the first ECG framework built on a decision decoder, a pretrained language model trained to return a probability for every listed option. A question-conditioned bridge compresses frozen waveform and spectrogram features into 16 ECG tokens, and a two-stage procedure adapts the bridge and low-rank adapters on the decoder's native option readout using diagnostic labels alone, scoring all options for a question in one forward pass. Evaluated across four ECG benchmarks, ECGJev achieves the highest macro-F1 on CPSC2018 (80.46%), PTB-XL (71.68%) and Chapman (96.86%), and generalizes competitively to the small-sample PTB cohort. Concept probes and perturbation analyses further show that its predictions rely directly on the ECG input, remain stable under option-order and wording variations, and transfer zero-shot to unseen waveform concepts. Our code is available at https://github.com/zhuoyuanli-lab/ECGJev.
Verbatim fromarXiv· arXiv metadata (abstracts are released under CC0)
Li, Z., Wu, X., Cui, H., Gao, J., Fu, R., Yan, M. and Tang, H. (2026) 'ECGJev: Question-Conditioned Option Scoring for 12-Lead ECG Interpretation (arXiv 2611.02041)', arXiv 2611.02041v1. Available at: https://arxiv.org/abs/2611.02041
Li, Zhuoyuan, et al. "ECGJev: Question-Conditioned Option Scoring for 12-Lead ECG Interpretation (arXiv 2611.02041)." arXiv 2611.02041v1, 2026. https://arxiv.org/abs/2611.02041.
Z. Li et al., "ECGJev: Question-Conditioned Option Scoring for 12-Lead ECG Interpretation (arXiv 2611.02041)," arXiv 2611.02041v1, 2026, [Online]. Available: https://arxiv.org/abs/2611.02041.
@misc{li2026ecgjev,
title = {{ECGJev: Question-Conditioned Option Scoring for 12-Lead ECG Interpretation (arXiv 2611.02041)}},
author = {Li, Zhuoyuan and Wu, Xidong and Cui, Hanyu and Gao, Jiansong and Fu, Rongrong and Yan, Mingke and Tang, Haotian},
year = {2026},
howpublished = {arXiv 2611.02041v1},
eprint = {2611.02041},
archivePrefix = {arXiv}
}
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The waveform is an illustration of a PPG pulse, not a recording.
