The Role of Wearable Devices in Cardiovascular Monitoring of Athletes: Implications for Sudden Cardiac Death Prevention
DOI:
https://doi.org/10.12775/JEHS.2026.94.73090Keywords
wearable devices, athletes, sudden cardiac death, cardiovascular monitoringAbstract
Background. Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) in athletes are rare but devastating events. Traditional prevention relies on preparticipation cardiovascular screening, which may not identify intermittent or exercise-induced abnormalities. Wearable technologies offer continuous cardiovascular monitoring and may support early detection of potential abnormalities.
Aim. To evaluate the role of wearable devices in cardiovascular monitoring of athletes and their potential contribution to SCA/SCD prevention.
Material and methods. A narrative review was performed using PubMed, Scopus, and Google Scholar. Original studies, reviews, and consensus statements on wearable devices, arrhythmia detection, heart rate variability, and SCA/SCD in athletes were analyzed qualitatively, with emphasis on recent literature.
Results. Wearable devices based on photoplethysmography (PPG) and wearable electrocardiography (ECG) allow monitoring of cardiovascular parameters during daily activity and exercise. Wearable ECG offers greater diagnostic value for arrhythmia detection, whereas PPG enables long-term monitoring but is more susceptible to artifacts. Heart rate variability and other derived metrics may reflect autonomic regulation, although their value in predicting serious cardiac events remains uncertain. Current evidence supports wearables as adjunctive tools for symptom evaluation and longitudinal monitoring rather than standalone preventive methods.
Conclusions. Wearable technologies show promise for cardiovascular monitoring in athletes but should currently complement rather than replace established screening strategies. Further prospective studies and standardized clinical guidelines are needed to define their role in sports cardiology.
References
1. Pelliccia A, Sharma S, Gati S, Bäck M, Börjesson M, Caselli S, et al. 2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease: The Task Force on sports cardiology and exercise in patients with cardiovascular disease of the European Society of Cardiology (ESC). Eur Heart J. 2021;42(1):17-96. https://doi.org/10.1093/eurheartj/ehaa605
2. Wilczyński R, Wdowiak W, Wrona W, Owsik J, Ludwisiak H, Dorożalska M. Sudden cardiac arrest and sudden cardiac death in athletes: an updated perspective. Health Problems of Civilization. 2026. https://doi.org/10.29316/hpc/220553.
3. Finocchiaro G, Papadakis M, Robertus JL, Dhutia H, Steriotis AK, Tome M, et al. Etiology of sudden death in sports: insights from a United Kingdom Regional Registry. J Am Coll Cardiol. 2016; 67(18): 2108-2115. https://doi.org/10.1016/j.jacc.2016.02.062
4. Finocchiaro G, Westaby J, Sheppard MN, Papadakis M, Sharma S. Sudden Cardiac Death in Young Athletes: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024;83(2):350-370. https://doi.org/10.1016/j.jacc.2023.10.032
5. Malik A, Hanson J, Han J, Dolezal B, Bradfield J, Boyle NG, et al. Sudden cardiac arrest in athletes and strategies to optimize preparedness. Clin Cardiol. 2023; 46(9): 1059-1071. https://doi.org/10.1002/clc.24095
6. Jensen MT, Treskes RW, Caiani EG, et al. ESC working group on e-cardiology position paper: use of commercially available wearable technology for heart rate and activity tracking in primary and secondary cardiovascular prevention-in collaboration with the European Heart Rhythm Association, European Association of Preventive Cardiology, Association of Cardiovascular Nursing and Allied Professionals, Patient Forum, and the Digital Health Committee. Eur Heart J Digit Health. 2021;2(1):49-59. Published 2021 Feb 8. https://doi.org/10.1093/ehjdh/ztab011
7. Moshawrab M, Adda M, Bouzouane A, Ibrahim H, Raad A. Smart Wearables for the Detection of Cardiovascular Diseases: A Systematic Literature Review. Sensors (Basel). 2023;23(2):828. Published 2023 Jan 11. https://doi.org/10.3390/s23020828
8. Abdelrazik A, Eldesouky M, Antoun I, et al. Wearable Devices for Arrhythmia Detection: Advancements and Clinical Implications. Sensors (Basel). 2025;25(9):2848. Published 2025 Apr 30. https://doi.org/10.3390/s25092848
9. Perez MV, Mahaffey KW, Hedlin H, et al. Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation. N Engl J Med. 2019;381(20):1909-1917. https://doi.org/10.1056/NEJMoa1901183
10. Malik A, Hanson J, Han J, Dolezal B, Bradfield J, Boyle NG, et al. Sudden cardiac arrest in athletes and strategies to optimize preparedness. Clin Cardiol. 2023; 46(9): 1059-1071. https://doi.org/10.1002/clc.24095
11. Petek BJ, Churchill TW, Moulson N, Kliethermes SA, Baggish AL, Drezner JA, et al. Sudden cardiac death in National Collegiate Athletic Association athletes: a 20-year study. Circulation. 2024; 149(2): 80-90. https://doi.org/10.1161/CIRCULATIONAHA.123.065908
12. Arzayus-Patiño L, Carabali-Bonilla YF, Mora-Salazar MC, Gómez CC, Benavides-Cordoba V. Cardiovascular diseases and risk factors associated with sudden cardiac death in amateur athletes: a scoping review. Front. Public Health. 2026; 14: 1770168. https://doi.org/10.3389/fpubh.2026.1770168
13. Muchaili L, Liwleya S, Siame L, Nzobokela J, Machacha B, Sinamwenda EN, et al. Atherosclerosis and sudden cardiac death in athletes. Current Problems in Cardiology. 2025; 50(9): 103123. https://doi.org/10.1016/j.cpcardiol.2025.103123
14. Maron BJ, Zipes DP, Kovacs RJ. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Preamble, Principles, and General Considerations: A Scientific Statement From the American Heart Association and American College of Cardiology. J Am Coll Cardiol. 2015;66(21):2343-2349. https://doi.org/10.1016/j.jacc.2015.09.032
15. Sgarro GA, Vasco P, Santoro D, Grilli L, Giglio M, Brunetti ND, et al. Identifying risk patterns for sudden cardiac death in athletes: a clustering and principal component analysis approach. PLoS One. 2026; 21(1): e0339377. https://doi.org/10.1371/journal.pone.0339377
16. Finocchiaro G, Papadakis M, Robertus JL, Dhutia H, Steriotis AK, Tome M, et al. Etiology of sudden death in sports: insights from a United Kingdom Regional Registry. J Am Coll Cardiol. 2016; 67(18): 2108-2115. https://doi.org/10.1016/j.jacc.2016.02.062
17. Han J, Lalario A, Merro E, Sinagra G, Sharma S, Papadakis M, et al. Sudden cardiac death in athletes: facts and fallacies. J Cardiovasc Dev Dis. 2023; 10(2): 68. https://doi.org/10.3390/jcdd10020068
18. Nelson BW, Low CA, Jacobson N, Areán P, Torous J, Allen NB. Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research. NPJ Digit Med. 2020;3:90. Published 2020 Jun 26. https://doi.org/10.1038/s41746-020-0297-4
19. Romagnoli S, Ripanti F, Morettini M, Burattini L, Sbrollini A. Wearable and Portable Devices for Acquisition of Cardiac Signals while Practicing Sport: A Scoping Review. Sensors (Basel). 2023;23(6):3350. Published 2023 Mar 22. https://doi.org/10.3390/s23063350
20. Petek BJ, Al-Alusi MA, Moulson N, et al. Consumer Wearable Health and Fitness Technology in Cardiovascular Medicine: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023;82(3):245-264. https://doi.org/10.1016/j.jacc.2023.04.054
21. Bayoumy K, Gaber M, Elshafeey A, et al. Smart wearable devices in cardiovascular care: where we are and how to move forward. Nat Rev Cardiol. 2021;18(8):581-599. https://doi.org/10.1038/s41569-021-00522-7
22. Georgiou K, Larentzakis AV, Khamis NN, Alsuhaibani GI, Alaska YA, Giallafos EJ. Can Wearable Devices Accurately Measure Heart Rate Variability? A Systematic Review. Folia Med (Plovdiv). 2018;60(1):7-20. https://doi.org/10.2478/folmed-2018-0012
23. Hinde K, White G, Armstrong N. Wearable Devices Suitable for Monitoring Twenty Four Hour Heart Rate Variability in Military Populations. Sensors (Basel). 2021;21(4):1061. Published 2021 Feb 4. https://doi.org/10.3390/s21041061
24. Fanous Y, Dorian P. Wearables for cardiac monitoring in athletes: precious metal or fool's gold?. Eur Heart J Digit Health. 2021;2(3):358-360. Published 2021 Jun 21. https://doi.org/10.1093/ehjdh/ztab056
25. Perino AC, Gummidipundi SE, Lee J, et al. Arrhythmias Other Than Atrial Fibrillation in Those With an Irregular Pulse Detected With a Smartwatch: Findings From the Apple Heart Study. Circ Arrhythm Electrophysiol. 2021;14(10):e010063. https://doi.org/10.1161/CIRCEP.121.010063
26. Manninger M, Kosiuk J, Zweiker D, et al. Role of wearable rhythm recordings in clinical decision making-The wEHRAbles project. Clin Cardiol. 2020;43(9):1032-1039. https://doi.org/10.1002/clc.23404
27. Hughes A, Shandhi MMH, Master H, Dunn J, Brittain E. Wearable Devices in Cardiovascular Medicine. Circ Res. 2023;132(5):652-670. https://doi.org/10.1161/CIRCRESAHA.122.322389
28. Palermi S, Vecchiato M, Saglietto A, et al. Unlocking the potential of artificial intelligence in sports cardiology: does it have a role in evaluating athlete's heart?. Eur J Prev Cardiol. 2024;31(4):470-482. https://doi.org/10.1093/eurjpc/zwae008
29. Lee S, Chu Y, Ryu J, Park YJ, Yang S, Koh SB. Artificial Intelligence for Detection of Cardiovascular-Related Diseases from Wearable Devices: A Systematic Review and Meta-Analysis. Yonsei Med J. 2022;63(Suppl):S93-S107. https://doi.org/10.3349/ymj.2022.63.S93
30. Castaneda D, Esparza A, Ghamari M, Soltanpur C, Nazeran H. A review on wearable photoplethysmography sensors and their potential future applications in health care. Int J Biosens Bioelectron. 2018;4(4):195-202. https://doi.org/10.15406/ijbsbe.2018.04.00125
31. Dinh-Le C, Chuang R, Chokshi S, Mann D. Wearable Health Technology and Electronic Health Record Integration: Scoping Review and Future Directions. JMIR Mhealth Uhealth. 2019;7(9):e12861. Published 2019 Sep 11. https://doi.org/10.2196/12861
32. Bent B, Goldstein BA, Kibbe WA, Dunn JP. Investigating sources of inaccuracy in wearable optical heart rate sensors. NPJ Digit Med. 2020;3:18. Published 2020 Feb 10. https://doi.org/10.1038/s41746-020-0226-6
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Copyright (c) 2026 Rafal Wilczynski, Nikola Samp, Jędrzej Foryński, Michelle Stachurska, Paweł Trzepizur, Kamila Zera, Beniamin Bekrycht, Weronika Piekarska, Konstancja Radiczew, Karolina Rogala

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