X-Beat: An Explainable Framework for ECG Image Classification

Mohammad Sadman Tahsin, Haitham Y. Adarbah, Afzel Noore

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…