What is the correct Electrocardiogram (ECG) lead placement?

From the Guidelines

The correct placement of electrocardiogram (ECG) leads involves specific anatomical positions for accurate cardiac electrical activity recording, with limb leads placed on the fleshy parts of the limbs and precordial leads positioned in specific intercostal spaces and lines on the chest, as recommended by the American Heart Association 1. For a standard 12-lead ECG, the limb leads should be placed as follows:

• RA (right arm) on the right wrist or shoulder
• LA (left arm) on the left wrist or shoulder
• RL (right leg) on the right ankle or thigh
• LL (left leg) on the left ankle or thigh The six precordial leads should be positioned as follows:
• V1 at the 4th intercostal space at the right sternal border
• V2 at the 4th intercostal space at the left sternal border
• V3 midway between V2 and V4
• V4 at the 5th intercostal space at the midclavicular line
• V5 at the same horizontal level as V4 at the anterior axillary line
• V6 at the same horizontal level as V4 at the mid-axillary line Proper lead placement is essential because incorrect positioning can lead to misinterpretation of the ECG, potentially resulting in missed diagnoses or inappropriate treatments, as noted in the American College of Cardiology Foundation guidelines 1. When placing leads, ensure the skin is clean and dry, and consider shaving areas with excessive hair to improve electrode contact, as recommended by the Heart Rhythm Society 1. Electrodes should be checked regularly during continuous monitoring as they may become displaced or lose adhesion over time, highlighting the importance of proper lead placement and maintenance in clinical practice 1.

From the Research

ECG Lead Placement

The correct Electrocardiogram (ECG) lead placement is crucial for accurate diagnosis and interpretation of heart conditions.

• The standard 12-lead ECG is widely used in clinical practice, as seen in the study by 2, which utilized 12-lead ECGs to predict atrial fibrillation risk.
• However, the provided studies do not specifically address the correct placement of ECG leads.
• The studies focus on the interpretation and analysis of ECG readings, such as the accuracy of physicians' ECG interpretations 3, the impact of expertise and clinical history on ECG interpretation 4, and the use of deep learning models for ECG disease detection 5.
• None of the studies provide detailed information on the correct placement of ECG leads, highlighting a gap in the available research.

Key Findings

• The studies demonstrate the importance of accurate ECG interpretation and analysis in diagnosing heart conditions.
• Expertise and clinical history can influence ECG interpretation, but the correct placement of ECG leads is not explicitly addressed.
• Advanced signal processing and deep learning techniques can improve ECG disease detection accuracy, as seen in the study by 5.

ECG Interpretation

• Accurate ECG interpretation is dependent on the perceptual skill of pattern recognition and specifically the time to fixate the critical lead(s), as noted in the study by 4.
• The use of deep learning models and P-QRS-T waveform features can enhance ECG disease detection accuracy, as demonstrated in the study by 5.