Electrocardiogram-Based Artificial Intelligence for Detection of Low Ejection Fraction: A Contemporary Review

Artificial intelligence (AI) is transforming the role of electrocardiography (ECG) in cardiovascular care, enabling early disease detection, improved risk stratification, and optimized therapeutic decision-making. This review explores recent advances in AI-enhanced ECG (AI-ECG) applications, with a focus on both technical innovations and clinical integration. Key developments include deep learning models capable of detecting structural heart disease, arrhythmias, and even systemic conditions from ECG data. Emphasis is placed on the need for model explainability, fairness, and generalizability through diverse training datasets and interpretable algorithms. Multimodal learning, federated approaches, and temporal modeling are highlighted as emerging strategies to enhance model robustness and clinical relevance. Integration into electronic health records, prospective validation studies, and regulatory considerations are discussed as essential steps toward real-world adoption. Additionally, AI-driven remote monitoring through wearable devices offers scalable solutions for early intervention, though challenges around accuracy, alarm fatigue, and cost-effectiveness remain. Finally, global collaboration and policy frameworks are necessary to ensure equitable, ethical, and sustainable deployment of AI-ECG technologies. Collectively, this work underscores the transformative potential of AI-ECG while outlining critical directions for its safe and effective implementation in clinical practice.