This paper presents a real-time adaptive ECG detection and delineation algorithm alongside an architecture based on time-domain signal processing of the ECG signal. The algorithm is enhanced to detect large number of different P-QRS-T waveform morphologies using adaptive search windows and adaptive threshold levels. The proposed architecture has been implemented in the state-of-the-art 65-nm CMOS technology. It occupied 0.03416 mm2 area and consumed 0.614 mW power. Furthermore, the non-complex nature of the architecture resulted with a realization using smaller number of computation and higher performance. The design of the QRS detector was tested on ECG records obtained from the Physionet QT database and achieved a sensitivity of Se =99.83% and a positive predictivity of P + = 98.65%. Similarly, the mean error values of the T peak, T offset, P peak and P offset were found to be -1.367, 6.36, 5.5 and -2.59 milliseconds, respectively, using the same database. The small area, low power, and high performance of our architecture makes it suitable for inclusion in System On Chips (SOCs) targeting wearable mobile medical devices.Index Terms-ECG signal, QRS detection, T-and P-wave delineation, ASIC design, hardware implementation, adaptive technique, low power.978-1-4799-8391-9/15/$31.00 ©2015 IEEE