Comparative Analysis of Data Augmentation for Clinical ECG Classification with STAR

Clinical 12-lead ECG classification remains difficult because of diverse recording conditions, overlapping pathologies, and pronounced label imbalance hinder generalization, while unconstrained augmentations risk distorting diagnostically critical morphology. In this study, Sinusoidal Time-Amplitude Resampling (STAR) is introduced as a beat-wise augmentation that operates strictly between successive R-peaks to apply controlled time warping and amplitude scaling to each R-R segment, preserving the canonical P-QRS-T order and leaving the head and tail of the trace unchanged. STAR is designed for practical pipelines and offers: (i) morphology-faithful variability that broadens training diversity without corrupting peaks or intervals; (ii) source-resilient training, improving stability across devices, sites, and cohorts without dataset-specific tuning; (iii) model-agnostic integration with common 1D SE-ResNet-style ECG encoders backbone; and (iv) better learning on rare classes via beat-level augmentation, reducing overfitting by resampling informative beats instead of duplicating whole records. In contrast to global crops, large shifts, or additive noise, STAR avoids transformations that suppress or misalign clinical landmarks. A complete Python implementation and a transparent training workflow are released, aligned with a source-aware, stratified five-fold protocol over a multi-institutional 12-lead corpus, thereby facilitating inspection and reuse. Taken together, STAR provides a simple and controllable augmentation for clinical ECG classification where trustworthy morphology, operational simplicity, and cross-source durability are essential.