Systematic Review of Artificial Intelligence and Electrocardiography for Cardiovascular Disease Diagnosis

Abstract

Cardiovascular diseases (CVDs) are the leading cause of death globally. Electrocardiograms (ECGs) are crucial diagnostic tools; however, their traditional interpretations exhibit limited sensitivity and reproducibility. This systematic review discusses the recent advances in artificial intelligence (AI), including deep learning and machine learning, applied to ECG analysis for CVD detection. It examines over 100 studies from 2019 to 2025, classifying AI applications by disease type (heart failure, myocardial infarction, and atrial fibrillation), model architecture (convolutional neural networks, long short-term memory, and hybrid models), and methodological innovation (signal denoising, synthetic data generation, and explainable AI). Comparative tables and conceptual figures highlight performance metrics, dataset characteristics, and implementation challenges. Our findings indicated that AI models outperform traditional methods, especially in terms of detecting subclinical conditions and enabling real-time monitoring via wearable technologies. Nonetheless, issues such as demographic bias, lack of dataset diversity, and regulatory hurdles persist. The review concludes by offering actionable recommendations to enhance clinical translation, equity, and transparency in AI-ECG applications. These insights aim to guide interdisciplinary efforts toward the safe and effective adoption of AI in cardiovascular diagnostics.