From Leads to Latents: Attention-Driven Masked Autoencoder for ECG Time Series

Electrocardiograms (ECGs) are among the most widely available clinical signals and play a central role in cardiovascular diagnosis. While recent foundation models have shown promise for learning transferable ECG representations, most existing pretraining approaches treat leads as independent channels and fail to explicitly leverage their strong structural redundancy. We introduce the latent attention masked autoencoder (LAMAE) framework that directly exploits this structure by learning cross-lead connection mechanisms during self-supervised pretraining. Our approach models higher-order interactions across leads through latent attention, enabling permutation-invariant aggregation and adaptive weighting of lead-specific representations. We provide empirical evidence on the Mimic-IV-ECG database that leveraging the cross-lead connection constitutes an effective form of structural supervision, improving representation quality and transferability. Our method shows strong performance on the difficult task of predicting ICD-10 codes, outperforming independent-lead masked modeling and alignment-based baselines.