Comparative Performance of Patch-Type and Lead-Type Wearable Electrocardiogram Devices for Arrhythmia Detection in Routine Clinical Practice

<b>Background/Objectives:</b> Wearable electrocardiogram (ECG) monitoring has become increasingly important in detecting atrial fibrillation (AF) and subclinical arrhythmias by addressing diagnostic gaps inherent to intermittent or asymptomatic presentations. In contemporary clinical practice, two major types of wearable ECG monitors-patch-type and lead-type-are widely used, each with distinct advantages and limitations. This study aims to compare these modalities and evaluate their respective strengths and constraints in real-world settings. <b>Methods:</b> We retrospectively analyzed 639 consecutive outpatients (mean age 61.7 ± 14.5 years; 56.7% male) who underwent wearable ECG monitoring between March 2022 and October 2023. Patients were stratified into patch-type (n = 466; 72.9%) and lead-type (n = 173; 27.1%) groups. Baseline characteristics were comparable. Indications, monitoring duration, arrhythmia detection, and noise rates were assessed. <b>Results:</b> Baseline characteristics did not differ significantly between the two groups. Lead-type monitoring was often prescribed for symptomatic patients (87.9% vs. 75.8%; <i>p</i> = 0.001), Symptomatic patients were older than asymptomatic patients (<i>p</i> = 0.040), whereas the proportion of males was higher in the asymptomatic group (<i>p</i> < 0.001). AF detection rates were comparable between the two groups (24.0% vs. 24.9%; <i>p</i> = 0.911). Patch-type monitoring achieved significantly longer recording duration (<i>p</i> < 0.001) and higher pause event detection (<i>p</i> = 0.004), but at the cost of increased noise burden (<i>p</i> < 0.001). <b>Conclusions:</b> Both patch-type and lead-type wearable ECGs are clinical applicable for arrhythmia surveillance in real-world practice. While AF detection rates were similar, the patch-type monitoring provided more extended observation periods and enhanced pause detection, though accompanied by a higher noise burden. These findings suggest that device selection should be individualized based on patient symptoms, monitoring goals, and tolerability. This study provides practical insights for optimizing wearable ECG use in routine practice.