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Does modifying electrode placement of the 12 lead ECG matter in healthy subjects?
MedLine Citation:
PMID:  20701990     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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 0.1mV, T wave changes greater than 0.5mV (frontal plane) or 1mV (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.
Authors:
James P Sheppard; Thomas A Barker; Aaron M Ranasinghe; Thomas H Clutton-Brock; Michael P Frenneaux; Michael J Parkes
Publication Detail:
Type:  Journal Article     Date:  2010-08-10
Journal Detail:
Title:  International journal of cardiology     Volume:  152     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2011 Oct 
Date Detail:
Created Date:  2011-10-04     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  184-91     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
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.
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