Abstract / Summary
Continuous and reliable monitoring of cardiac bio potentials such as the electrocardiogram (ECG) is essential for early diagnosis and long-term healthcare management. Conventional Ag/AgCl gel electrodes, although clinically established, are limited by skin irritation, gel dehydration, and poor reusability, making them unsuitable for continuous and wearable monitoring. This systematic review aims to evaluate the evolution, performance, and applicability of fabric-based, graphene-based, and hybrid textile electrodes for medical-grade and consumer-grade wearable ECG monitoring. This review was conducted in accordance with the PRISMA 2020 guidelines. Five electronic data-bases-IEEE Xplore, Scopus, Web of Science, ScienceDirect, and PubMed-were systematically searched, resulting in 182 peer-reviewed studies published between 2015 and 2025 that met the inclusion criteria. The included studies were thematically synthesized based on material type, fabrication technique, and performance metrics. The synthesis reveals a clear progression from conductive-thread, knitted, and woven textile electrodes toward graphene-based and hybrid systems, driven by improvements in electrical conductivity, skin-electrode impedance, signal-to-noise ratio (SNR), biocompatibility, and wash durability. In particular, multilayer graphene-polymer textile electrodes demonstrate performance comparable to clinical Ag/AgCl electrodes while offering superior comfort, reusability, and long-term stability under sweat, motion, and repeated laundering. These findings highlight graphene-based textile electrodes as strong candidates for next-generation wearable biopotential monitoring systems and provide evidence-based guidance for future research focused on standardization, scalability, and clinical translation.