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Does modifying electrode placement of the 12 lead ECG matter in healthy subjects?

Abstract：

BACKGROUND:Limb electrodes for the 12 lead ECG are routinely placed on the torso during exercise stress testing or when limbs are clinically inaccessible. It is unclear whether such electrode modification produces ECG changes in healthy male or female subjects that are clinically important according to the 2009 AHA, ACCF, HRS guidelines. We therefore measured whether ECG modification produced clinically important or false positive ECG changes e.g., appearance of Q waves in leads V(1-3), ST changes greater than 0.1 mV, T wave changes greater than 0.5 mV (frontal plane) or 1 mV (transverse plane), QRS axis shifts or alterations to QTc/P-R/QRS intervals. METHODS:The 12 lead ECG was measured in 18 healthy and semi-recumbent subjects using the standard and Takuma modified limb placements. RESULTS:In the frontal plane we demonstrate that the modification of limb electrode placement produces small Q, R and T wave amplitude and QRS axis changes that are statistically but not clinically significant. In the transverse plane it produces no statistically or clinically significant changes in the ECG or in ST segment morphology, P-R, QRS or QTc intervals. CONCLUSIONS:We provide better and more robust evidence that routine modification of limb electrode placement produces only minor changes to the ECG waveform in healthy subjects. These are not clinically significant according to the 2009 guidelines and thus have no effect on the clinical specificity of the 12 lead ECG.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Sheppard JP,Barker TA,Ranasinghe AM,Clutton-Brock TH,Frenneaux MP,Parkes MJ

doi

10.1016/j.ijcard.2010.07.013

subject

Has Abstract

pub_date

2011-10-20 00:00:00

pages

184-91

issue

2

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(10)00540-1

journal_volume

152

pub_type

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