AI-Enabled Sensor Technologies for Remote Arrhythmic Monitoring in High-Risk Cardiomyopathy Genotypes

Inherited cardiomyopathies associated with high-risk genotypes, are characterized by a disproportionate risk of malignant ventricular arrhythmias and sudden cardiac death, often independent of left ventricular systolic dysfunction or advanced structural remodeling. Traditional surveillance strategies based on intermittent electrocardiography and phenotype-driven risk assessment are insufficient to capture the dynamic and often silent progression of electrical instability in these populations. This narrative review evaluates the emerging role of artificial intelligence (AI)-enabled sensor technologies in remote arrhythmic monitoring of genetically defined cardiomyopathy cohorts. Wearable ECG devices, implantable cardiac monitors, multisensor cardiac implantable electronic device algorithms, pulmonary artery pressure sensors, and contact-free systems enable continuous acquisition of electrophysiological and hemodynamic data, generating digital biomarkers that may reflect early arrhythmic vulnerability and subclinical decompensation. AI-driven analytics enhance signal processing, automated event detection, and remote data triage, with the potential to reduce clinical workload while preserving diagnostic sensitivity. However, current evidence predominantly derives from heterogeneous heart failure or general arrhythmia populations, and prospective validation in genotype-specific cohorts remains limited. Key challenges include algorithm generalizability, signal quality in ambulatory environments, data governance, interpretability of AI models, and integration into structured remote-care pathways. The convergence of genotype-informed risk stratification and multimodal AI-enabled sensing represents a promising strategy to transition from reactive device-based protection to proactive, precision-guided arrhythmic prevention. Dedicated genotype-focused studies and standardized digital endpoints are required to support safe and effective implementation in inherited cardiomyopathies.