Wear Your Heart on Your Sleeve: Smart Textile ECG Wearables for Comfort, Integration, Signal Quality and Continuous Monitoring in Paroxysmal Atrial Fibrillation

Atrial fibrillation (AF), a prevalent cardiac arrhythmia and a major contributor to stroke risk, is anticipated to increase in incidence with the aging global population. For effective AF management, particularly for paroxysmal AF (PAF), long-term and accurate monitoring is essential. However, traditional monitoring methods, including Holter ECGs and implantable cardiac monitors (ICMs), present limitations in comfort, compliance and extended monitoring capabilities. Recent advancements in wearable technology have introduced smart textile-based ECG devices, which incorporate electrochemical sensors into fabrics, enabling non-invasive, continuous monitoring while enhancing user comfort. This review evaluates textile-based ECG devices by comparing their performance-assessed through AF detection rates, signal-to-noise ratio (SNR) and total analysis time-against conventional Holter monitoring and the 12-lead ECG. Furthermore, this review examines user acceptability factors, including patient-reported comfort, usability during resting and physical activities and skin-related adverse effects. The findings aim to provide insights for future device development and facilitate their integration into clinical practice.