BEAT-Net: Injecting Biomimetic Spatio-Temporal Priors for Interpretable ECG Diagnosis

Abstract

Automated electrocardiogram diagnosis using deep learning remains limited by signal-agnostic representations that treat multi-lead recordings as undifferentiated time-series or images, forcing models to rediscover physiological structure implicitly. This leads to data inefficiency, poor generalization, and opaque decision boundaries misaligned with clinical reasoning. We present BEAT-Net, a supervised biomimetic framework that integrates QRS-centered biological tokenization with a hierarchical architecture mirroring the cardiologist's workflow. A QRS tokenizer converts continuous signals into semantically complete heartbeat sequences, which are processed through four specialized stages: morphological feature extraction via a Word Encoder, lead-invariant normalization through a Spatial Operator, temporal context injection by a Temporal Operator, and global reasoning using a Transformer-based Sentence Encoder. Evaluated across three large-scale benchmarks including PTB-XL, CPSC2018, and CSN, BEAT-Net achieves diagnostic accuracy of 0.924 AUC, comparable to dominant CNN baselines at 0.925 AUC, while reducing parameters by 95 percent from 2.06 million to 0.7 million. Critically, BEAT-Net surpasses the 39.5-million-parameter foundation model HeartLang on morphological Form classification, reaching 0.901 AUC compared to HeartLang's 0.832 AUC, while attaining full CNN-level performance using only 35 percent of training data and exhibiting superior cross-dataset generalization. Learned attention patterns spontaneously align with established clinical heuristics, demonstrating that explicit physiological structure provides a more efficient and interpretable alternative to massive pre-training for clinical deployment.