ECG sonification methods for robust and generalizable clinical decision support

Electrocardiography (ECG) sonification has emerged as a complementary modality to visual waveform interpretation, enabling diagnostic cues to be conveyed through sound in real time. This review synthesizes evidence from the past decade to establish the current methodological landscape and gaps in ECG sonification research. A structured search identified eight peer-reviewed studies (2015-2025) that applied auditory transformation of ECG signals for diagnosis, monitoring, or therapeutic guidance. We analyzed signal acquisition methods, preprocessing pipelines, mapping strategies (including parameter mapping and amplitude/frequency modulation, with optional machine-learning decoding), evaluation endpoints, and common limitations. Reported benefits included enhanced perceptual cue detection, alternative feedback channels, and support for cognitive load reduction. However, generalizability was limited by small sample sizes, inconsistent reporting of audio design parameters, and minimal clinical validation. We propose minimum reporting standards and a staged evaluation pathway to enable robust, reproducible, and clinically translatable ECG sonification systems.