How Much Temporal Modeling is Enough? A Systematic Study of Hybrid CNN-RNN Architectures for Multi-Label ECG Classification

Abstract: Accurate multi-label classification of electrocardiogram (ECG) signals remains challenging due to the coexistence of multiple cardiac conditions, pronounced class imbalance, and long-range temporal dependencies in multi-lead recordings. Although recent studies increasingly rely on deep and stacked recurrent architectures, the necessity and clinical justification of such architectural complexity have not been rigorously examined. In this work, we perform a systematic comparative evaluation of convolutional neural networks (CNNs) combined with multiple recurrent configurations, including LSTM, GRU, Bidirectional LSTM (BiLSTM), and their stacked variants, for multi-label ECG classification on the PTB-XL dataset comprising 23 diagnostic categories. The CNN component serves as a morphology-driven baseline, while recurrent layers are progressively integrated to assess their contribution to temporal modeling and generalization performance. Experimental results indicate that a CNN integrated with a single BiLSTM layer achieves the most favorable trade-off between predictive performance and model complexity. This configuration attains superior Hamming loss (0.0338), macro-AUPRC (0.4715), micro-F1 score (0.6979), and subset accuracy (0.5723) compared with deeper recurrent combinations. Although stacked recurrent models occasionally improve recall for specific rare classes, our results provide empirical evidence that increasing recurrent depth yields diminishing returns and may degrade generalization due to reduced precision and overfitting. These findings suggest that architectural alignment with the intrinsic temporal structure of ECG signals, rather than increased recurrent depth, is a key determinant of robust performance and clinically relevant deployment.