Lead errorsIntroduction

Incorrect placement of lead cables on thepatient’s body may be a significant cause ofdiagnostic errors in clinical practice

Rudiger analyzed 838 ECGs at the cardiology outpatient clinic and the ICU of the London University College. The frequency of ECG artifacts due to switched electrodes was 0.4% at the outpatient clinic and 4% at the ICU

Rudiger A,Hellermann JP, Mukherjee R, Follath F, Turina J. Electrocardiographic artifacts due to electrode misplacement and their frequency in clinical settings. Am J Emer Med (2007) 25(2):174-8

Possible lead misplacement should be considered every time unusual and/or

unexpected changes of the ECG pattern occur

ERRORS INVOLVING THE LIMB LEADSMisplacement of the Einthoven limb leads

- lead reversal, common (eg. Right arm- left arm reversal)

- more complex misplacements (uncommon) Miplacement of the ground cable (eg. Right arm –

right leg cable reversal) Detached or broken electrode/cable

Ground

UNIPOLAR CHEST LEADS

-ERRORS INVOLVING THE CHEST LEADS-Incorrect placement of a lead electrode-Lead reversal (eg. V1-V3 reversal)-Detached/non-functional electrode/cable(s)