<![CDATA[Objective: Cardiovascular disease remains the leading cause of death worldwide, and early arrhythmia detection through electrocardiography (ECG) is critical; however, access to conventional ECG equipment at primary healthcare facilities remains limited. Portable Internet of Things (IoT)-based tele-electrocardiography (tele-ECG) systems have been proposed to close this gap; however, evidence on their architecture, signal quality, and transmission reliability remains scattered, with no integrated synthesis available. This review maps IoT-based Tele-ECG architecture, signal quality methods, and transmission reliability challenges, identifying gaps relative to prior scoping reviews on wearable and home-use ECG devices. Method: A Systematic Literature Review was conducted following PRISMA, searching Scopus and IEEE Xplore on 9 July 2026. Three independent reviewers screened the records and assessed full-text eligibility, with study quality appraised using the Mixed Methods Appraisal Tool. From 55 initial records, 31 studies (2020–2026) met the full-text verified inclusion criteria. Results: Low-cost architectures were dominated by AD8232/AD823X/MAX30003 sensors paired with ESP32/ESP8266/ STM32/nRF-series microcontrollers (48.4% of studies), which transmitted data via Bluetooth Low Energy, Wi-Fi, or cloud platforms. Signal quality evaluation relies on Signal Quality Index metrics or deep learning classifiers (29.0%), while reported challenges span latency, packet loss, power consumption, and data security. Novelty: Unlike prior reviews addressing device technology or clinical validation separately, this review is the first to jointly synthesize architecture, signal quality, and transmission reliability evidence for IoT-based Tele-ECG systems, revealing that no study has evaluated all three dimensions within one integrated protocol under realistic, resource-limited network conditions, which is a gap with direct implications for future low-cost Tele-ECG system design and validation.]]>
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