Extreme learning machine (ELM) has shown to be an effective and low-power approach for real-time electrocardiography (ECG) anomaly detection. However, prior ELM inference chips are noise-prone and lacking in reconfigurability. In this article, we present an arbitrarily reconfigurable ELM inference engine fabricated in 40-nm CMOS technology for robust ECG anomaly detection. By combining Adaptive boosting (Adaboost) and Eigenspace denoising with ELM (AE-ELM), robust classification under noisy conditions is achieved and saves the number of required multiplications by 95.9%. For chip implementation, a reconfigurable VLSI architecture is designed to support arbitrary complexity of AE-ELM, accounting for dynamic change in application requirements. On the other hand, we propose to construct the input weight matrix of ELM as a Bernoulli random matrix, which further reduces the number of multiplications by 55.2%. For real-time detection, parallel computing is exploited to reduce the latency by up to 86.8%. Overall, the 0.21-mm 2 AE-ELM inference engine shows its robustness against noisy signals and achieves 1.83x AEE compared with the state-of-the-art ELM design. INDEX TERMS Adaptive boosting (Adaboost), eigenspace denoising, electrocardiography (ECG) anomaly detection, extreme learning machine (ELM), reconfigurable chip design.