Relative utility of portable ECG devices in capturing arrhythmias in athletes

Introduction: Traditional monitoring of athletes with cardiac symptoms is limited due to sport-specific considerations and the intermittent nature of symptoms. Some portable electrocardiogram (ECG) devices may have more diagnostic utility than traditional monitoring. Their accuracy, advantages, and limitations should be considered when a clinician is considering the most appropriate device for investigation of an athlete’s symptoms. Areas covered: There are six main categories of portable ECG devices: smartwatches, handheld devices, mobile cardiac telemetry (MCT), patches, rings, and chest sensors. The aim of this review is to highlight to a clinician the potential benefits of some devices over others to assist the physician in identifying the most appropriate device. We present peer-reviewed literature on the accuracy of each type of device along with advantages and limitations. Expert opinion: For a user-initiated capture of an ECG, smartwatches and handheld devices are easy to use and supported by peer-reviewed literature. Rings can also provide a user-initiated ECG, though there is limited evidence to support their usage. For continuous monitoring, patches and MCT are both useful, though there is limited access to these devices. Chest sensors show some promise, although access is currently limited in some countries.