Remote and Wearable ECG Devices with Diagnostic Abilities in Adults: A State-of-the-Science Scoping Review

The electrocardiogram (ECG) records the electrical activity in the heart in real-time, providing an important opportunity to detecting various cardiac pathologies. The 12-lead ECG currently serves as the “standard” ECG acquisition technique for diagnostic purposes for many cardiac pathologies other than arrhythmias. However, the technical aspects of acquiring a 12-lead ECG are not easy and its usage is currently restricted to trained medical personnel, limiting the scope of its usefulness. Remote and wearable ECG devices have attempted to bridge this gap by enabling patients to take their own ECG using a simplified method at the expense of a reduced number of leads, usually a single-lead ECG. In this review article, we summarize the studies which investigate the use of remote ECG devices and their clinical utility in diagnosing cardiac pathologies. Eligible studies discussed FDA-cleared, commercially available devices that were validated on an adult population. We summarize technical logistics of signal quality and device reliability, dimensional and functional features, and diagnostic value. In summary, our synthesis shows that reduced-set ECG wearables have huge potential for long-term monitoring, particularly if paired with real-time notification techniques. Such capabilities make them primarily useful for abnormal rhythm detection and there is sufficient evidence that a remote ECG device can be more superior to traditional 12-lead ECG in diagnosing specific arrhythmias such as atrial fibrillation. However, this review identifies important challenges faced by this technology, highlighting the limited availability of clinical research examining their usefulness.