CoFE: A Framework Generating Counterfactual ECG for Explainable Cardiac AI-Diagnostics

Recognizing the need for explainable AI (XAI) approaches to enable the successful integration of AI-based ECG prediction models (AI-ECG) into clinical practice, we introduce a framework generating $\mathbf{\text{Co}}$unter$\mathbf{\text{F}}$actual $\mathbf{\text{E}}$CGs (i,e., named CoFE) to illustrate how specific features, such as amplitudes and intervals, influence the model’s predictive decisions. To demonstrate the applicability of the CoFE, we present two case studies: atrial fibrillation classification and potassium level regression models. The CoFE reveals feature changes in ECG signals that align with the established clinical knowledge. By clarifying both $\mathbf{\text{where}}\mathbf{\text{valid}}\mathbf{\text{features}}\mathbf{\text{appear}}$ in the ECG and $\mathbf{\text{how}}\mathbf{\text{they}}\mathbf{\text{influence}}\mathbf{\text{the}}\mathbf{\text{model’s}}\mathbf{\text{predictions}}$, we anticipate that our framework will enhance the interpretability of AI-ECG models and support more effective clinical decision-making. Our demonstration video is available at: https://www.youtube.com/watch?v=YoW0bNBPglQ.