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This paper presents a real-time electrocardiogram (ECG) monitoring system for wearable devices. The system is based on the proposed parallel delta modulator architecture with local maximum point and local minimum point algorithms to detect QRS and PT waves. Therefore, using the proposed system and algorithm, real-time PR and RT intervals, and ST segment measurements can be achieved in long-term wearable ECG recording. The algorithm is tested with the MIT-BIH Arrhythmia Database for QRS complex detection and with the QT Database for the P and T wave detections. The simulation result shows that the algorithm achieves above 99%, 91%, and 98% accuracy in the QRS complex, P wave, and T wave detections, respectively. Experimental results are presented from the system prototype, in which the parallel delta modulator circuits are fabricated in IBM 0.13 $\mu \text{m}$ standard CMOS technology and the algorithms are implemented in a Xilinx Spartan-6 field programmable gate array (FPGA). The parallel delta modulators consume 720 nW at 1 kHz sampling rate with $\pm$0.6 V power supply. The proposed system has the potential to be applied in future long-term wearable ECG recording devices.

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