Robust AI-ECG for Predicting Left Ventricular Systolic Dysfunction in Pediatric Congenital Heart Disease

Artificial intelligence-enhanced electrocardiogram (AI-ECG) has shown promise as an inexpensive, ubiquitous, and non-invasive screening tool to detect left ventricular systolic dysfunction in pediatric congenital heart disease. However, current approaches rely heavily on large-scale labeled datasets, which poses a major obstacle to the democratization of AI in hospitals where only limited pediatric ECG data are available. In this work, we propose a robust training framework to improve AI-ECG performance under low-resource conditions. Specifically, we introduce an on-manifold adversarial perturbation strategy for pediatric ECGs to generate synthetic samples that better reflect real-world signal variations. Building on this, we develop an uncertainty-aware adversarial training algorithm that is architecture-agnostic and enhances model robustness. Internal and external evaluation on real-world pediatric (n=178,495) and adult (n=100,000) datasets demonstrates that our method enables low-cost and reliable detection of left ventricular systolic dysfunction, highlighting its potential for deployment in resource-limited clinical settings.