X-Beat: An Explainable Framework for ECG Image Classification

Abstract

Accurate automated interpretation of electrocardio- grams (ECGs) is essential for early detection of cardiac condi- tions such as myocardial infarction and rhythm abnormalities. However, many high-performing deep learning models remain difficult to deploy in clinical settings due to limited transparency and lack of reliability validation. In this work, we present X- Beat, an explainable and reliability-aware benchmark framework for ECG image classification designed to support trustworthy AI systems in healthcare. The proposed framework combines transfer learning with post-hoc explainability and systematic reliability evaluation across four cardiac classes: Abnormal Heartbeat, History of Myocardial Infarction, Myocardial In- farction, and Normal Heartbeat. Multiple ImageNet-pretrained CNN backbones, including EfficientNet-B0, ResNet-50, DenseNet- 121, and MobileNetV3-Large, are evaluated under a unified training protocol. Beyond standard performance metrics, we incorporate Grad-CAM-based visual explanations together with additional analyses, including explanation stability, regional sen- sitivity, and confidence-based reliability assessment, to examine whether model predictions are supported by clinically meaningful evidence. Experimental results show that ResNet-50 achieves the best performance, reaching 91.94% accuracy and a macro F1- score of 0.9098, with strong class separability (AUC up to 0.995). Explanation analyses indicate that the model primarily focuses on waveform-relevant regions, while reliability evaluation suggests that most incorrect predictions occur with lower confidence. Overall, this work provides a structured and reproducible bench- mark for evaluating both predictive performance and explanation reliability in ECG image classification, contributing toward the development of trustworthy and interpretable AI components for clinical decision support systems.