Billions of paper Electrocardiograms (ECGs) are recorded annually worldwide, particularly in the Global South. Manual review of this massive dataset is time-consuming and inefficient. Accurate digital reconstruction of these records is essential for efficient cardiac disease diagnosis. This paper proposes a systematic framework for digitizing paper ECGs with 12 symmetrically distributed leads and identifying abnormal samples. This method consists of three main components. First, we introduce an adaptive rotated convolution network to detect the positions of lead waveforms. By exploiting the symmetric distribution of 12 leads, a novel loss is proposed to improve the detection model’s performance. Second, image processing techniques, including denoising and connected component analysis, are employed to digitize ECG waveforms. Finally, we propose a transformer-based classification method combined with a state space model. Our process is evaluated on a large synthetic dataset, including ECG images characterized by rotations, noise, and creases. The results demonstrate that the proposed detection method can effectively reconstruct paper ECGs, achieving an 11% improvement in SNR compared to the baseline. Moreover, our classification model exhibits slightly higher performance than other counterparts. The proposed approach offers a promising solution for the automated analysis of paper ECGs, supporting clinical decision-making.
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