Wearable and Portable Electrocardiographic Devices as Modern Cardiac Telemetry Solutions in Pediatrics: A Systematic Review

Background/Objectives: Portable and wearable ECG technologies are increasingly used in adult cardiac monitoring. However, evidence supporting their feasibility and diagnostic performance in pediatric populations remains limited. This systematic review evaluates the diagnostic accuracy, usability, artifact susceptibility, and user acceptance of mobile ECG technologies in pediatric cardiology. Methods: A systematic literature search was performed in the Embase, PubMed, Scopus, and Web of Science databases. The review was conducted in accordance with the PRISMA 2020 guidelines and was registered in the PROSPERO database. Results: A total of 30 publications were included in the final analysis. Portable ECG devices demonstrated good feasibility diagnostic utility in children. Handheld systems provided high-quality tracings with strong agreement with standard 12-lead ECGs and higher adherence, as well as user satisfaction compared with conventional event recorders. However, automated rhythm classification frequently misidentified pediatric arrhythmias. Smartwatch-based ECG recordings showed high diagnostic accuracy when manually interpreted, but automated algorithms were unreliable, particularly for tachyarrhythmias and conduction abnormalities. Alternative electrode placement strategies improved smartwatch performance, and patient acceptance was consistently high. ECG patch monitoring, particularly with extended-wear devices, achieved the highest diagnostic yield, detecting arrhythmias often missed by short-duration Holter monitoring while maintaining comparable signal quality. Conclusions: Mobile ECG technologies represent a promising adjunct for pediatric rhythm surveillance, offering diagnostic performance comparable to standard modalities when interpreted by clinicians and improved usability and patient acceptance. Persistent limitations include the poor reliability of adult-oriented automated algorithms and the underrepresentation of younger children and the predominantly off-label use of these devices in pediatric populations, underscoring the need for pediatric-specific algorithm development and age-adapted device design.