Background: With the increase in the elderly population, the prevalence of persistent atrial fibrillation (AF) among older adults has significantly risen, becoming one of the crucial cardiovascular diseases affecting the health and quality of life of the elderly. Patients with persistent AF require continuous cardiac function monitoring to prevent possible complications such as stroke and heart failure. Traditional monitoring methods often necessitate frequent hospital visits, increasing the economic burden and psychological stress on patients. With advancements in medical technology, wireless smart monitoring systems have emerged as a new remote health care technology, offering a more convenient and effective monitoring option for patients with persistent AF. Specialist nurses play a pivotal role in monitoring and managing patients using these systems. Their professional knowledge and skills are vital for improving monitoring efficiency and patient compliance. Therefore, this study aims to explore the application of wireless smart monitoring systems led by specialist nurses in elderly patients with persistent AF, in hopes of providing a scientific basis for improving the monitoring and management of this patient group. Methods: A total of 88 elderly patients with persistent atrial fibrillation admitted to the Cardiology Ward of a tertiary hospital in Weifang City from October 2021 to April 2023 were selected as research subjects. They were divided into an intervention group and a control group with conventional care, with 44 cases in each group, according to the order of admission. The control group received conventional hospitalization guidance, while the intervention group utilized a wireless smart monitoring system led by specialist nurses. The effects before and after the intervention in both groups were compared. Results: The intervention group patients had better scores in terms of mental stress, sleep quality, and comfort compared with the control group, and the nursing shift change time during hospitalization for the intervention group was shorter than that of the control group (P<0.05). Conclusions: The wireless smart monitoring system led by specialist nurses can improve the mental stress and sleep conditions of elderly patients with persistent atrial fibrillation, increase comfort, and enhance the efficiency of nursing shift changes.