International Journal of Cardiology
Volume 152, Issue 2 , Pages 184-191 , 20 October 2011

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

  • James P. Sheppard

      Affiliations

    • Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
    • School of Sport and Exercise Sciences, University of Birmingham, UK
  • ,
  • Thomas A. Barker

      Affiliations

    • Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
    • Department of Cardiovascular Medicine, University of Birmingham, UK
  • ,
  • Aaron M. Ranasinghe

      Affiliations

    • Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
    • Department of Cardiovascular Medicine, University of Birmingham, UK
  • ,
  • Thomas H. Clutton-Brock

      Affiliations

    • Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
    • Department Anaesthesia and Intensive Care Medicine, University of Birmingham, UK
  • ,
  • Michael P. Frenneaux

      Affiliations

    • Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
    • Department of Cardiovascular Medicine, University of Birmingham, UK
    • School of Medicine, University of Aberdeen, UK
  • ,
  • Michael J. Parkes

      Affiliations

    • Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B15 2TH, UK
    • School of Sport and Exercise Sciences, University of Birmingham, UK
    • Corresponding Author InformationCorresponding author. School of Sport and Exercise Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK. Tel.: +44 121 414 6977; fax: +44 121 414 4121.

Received 24 February 2010 ,Revised 28 May 2010 ,Accepted 4 July 2010.

References 

  1. Einthoven W. The different forms of the human electrocardiogram and their signification. Lancet. 1912;1:853–861
  2. Barnes A, Pardee HEB, White PD, Wilson FN, Wolferth CC. Standardization of precordial leads — supplementary report. Am Heart J. 1938;15:235–239
  3. Mason RE, Likar I. A new system of multiple-lead exercise electrocardiography. Am Heart J. 1966;71:196
  4. Diamond D, Griffith DH, Greenberg ML, Carleton RA. Torso mounted electrocardiographic electrodes for routine clinical electrocardiography. J Electrocardiol. 1979;12:403–406
  5. Edenbrandt L, Pahlm O, Sornmo L. An accurate exercise lead system for bicycle ergometer tests. Eur Heart J. 1989;10:268–272
  6. Sevilla DC, Dohrmann ML, Somelofski CA, Wawrzynski RP, Wagner NB, Wagner GS. Invalidation of the resting electrocardiogram obtained via exercise electrode sites as a standard 12-lead recording. Am J Cardiol. 1989;63:35–39
  7. Krucoff MW, Loeffler KA, Haisty WK, et al. Simultaneous st-segment measurements using standard and monitoring-compatible torso limb lead placements at rest and during coronary-occlusion. AJCardiol. 1994;74:997–1001
  8. Takuma K, Hori S, Sasaki J, et al. An alternative limb lead system for electrocardiographs in emergency patients. Am J Emerg Med. 1995;13:514–517
  9. Gamble P, Mcmanus H, Jensen D, Froelicher V. A comparison of the standard 12-lead electrocardiogram to exercise electrode placements. Chest. 1984;85:616–622
  10. Jowett NI, Turner AM, Cole A, Jones PA. Modified electrode placement must be recorded when performing 12-lead electrocardiograms. Postgrad Med J. 2005;81:122–125
  11. Kleiner JP, Nelson WP, Boland MJ. 12-lead electrocardiogram in exercise testing — misleading baseline. Arch Intern Med. 1978;138:1572–1573
  12. Pahlm O, Haisty WK, Edenbrandt L, et al. Evaluation of changes in standard electrocardiographic QRS waveforms recorded from activity-compatible proximal limb lead positions. Am J Cardiol. 1992;69:253–257
  13. Papouchado M, Walker PR, James MA, Clarke LM. Fundamental differences between the standard 12-lead electrocardiograph and the modified (Mason-Likar) exercise lead system. Eur Heart J. 1987;8:725–733
  14. Wiens RD, Chaitman BR. An alternate limb lead system for electrocardiograms in emergency patients. Am J Emerg Med. 1997;15:94
  15. Kligfield P, Gettes LS, Bailey JJ, et al. Recommendations for the standardization and interpretation of the electrocardiogram: part I: the electrocardiogram and its technology: a scientific statement from the american heart association electrocardiography and arrhythmias committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society endorsed by the International Society for Computerized Electrocardiology. Circ J Am Heart Soc. 2007;115:1306–1324
  16. Rautaharju PM, Surawicz B, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram part IV: the ST segment, T and U waves, and the QT interval. J Am Coll Cardiol. 2009;53:982–991
  17. Surawicz B, Childers R, Deal BJ, Gettes LS. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram part III: intraventricular conduction disturbances. J Am Coll Cardiol. 2009;53:976–981
  18. Wagner GS, Macfarlane P, Wellens H, et al. AHA/ACCF/HRS recommendations for the standardization and interpretation of the electrocardiogram part VI: acute ischemia/infarction. J Am Coll Cardiol. 2009;53:1003–1111
  19. Wagner GS. In: Marriott's practical electrocardiography. 11th ed. Philadelphia: Lippincott, Williams and Wilkins; 2008;p. 1–468
  20. Wilson FN, Johnston FD, Macleod G, Barker PS. Electrocardiograms that represent the potential variations of a single electrode. Am Heart J. 1934;9:447–458
  21. Goldberger E. Simple, indifferent, electrocardiographic electrode of zero potential and a technique of obtaining augmented, unipolar, extremity leads. Am Heart J. 1942;23:483–492
  22. Rutherford JJ, Clutton-Brock TH, Parkes MJ. Hypocapnia reduces the T wave of the electrocardiogram in normal human subjects. Am J Physiol. 2005;289:R148–R155
  23. Braunwald E, Zipes DP, Libby P. Heart Disease, a textbook of cardiovascular medicine. 6th ed.. Philadelphia: W.B. Saunders Company; 2001;1–2297
  24. Houghton AR, Gray D. In: The axis. Macking sense of the ECG: a hands on guide. 2nd ed. New York: Arnold; 2003;p. 79–96
  25. Kenigsberg DN, Khanal S, Kowalski M, Krishnan SC. Prolongation of the QTc interval is seen uniformly during early transmural ischemia. J Am Coll Cardiol. 2007;49:1299–1305
  26. Bidoggia H, Maciel JP, Capalozza N, et al. Sex-dependent electrocardiographic pattern of cardiac repolarization. Am Heart J. 2000;140:430–436
  27. Macfarlane PW. Age, sex and the ST amplitude in health and disease. J Electrocardiol. 2001;34:235–241
  28. Surawicz B, Parikka H. Prevalence of male and female patterns of early ventricular repolarization in the normal ECG of males and females from childhood to old age. J Am Coll Cardiol. 2002;40:1870–1876
  29. Rautaharju PM, Prineas RJ, Crow RS, Seale D, Furberg C. The effect of modified limb electrode positions on electrocardiographic wave amplitudes. J Electrocardiol. 1980;13:109–113
  30. Coats AJ. Ethical authorship and publishing. Int J Cardiol. 2009;131:149–150

 This paper presents independent research awarded under NEAT (New and Emerging Applications of Technology), part of the Invention for Innovation (i4i) programme of the National Institute for Health Research (NIHR). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

PII: S0167-5273(10)00540-1

doi: 10.1016/j.ijcard.2010.07.013

International Journal of Cardiology
Volume 152, Issue 2 , Pages 184-191 , 20 October 2011