title: Electrocardiographic artifacts due to electrode misplacement and their frequency in different clinical settings.
abstract: Misplacement of electrodes can change the morphology of an electrocardiogram (ECG) in clinical important ways. To assess the frequency of these errors in different clinical settings, we collected ECGs routinely performed at the cardiology outpatient clinic and the intensive care unit. Lead misplacement was suspected when one of the following morphological changes occurred: QRS axis between 180 degrees and -90 degrees , positive P wave in lead aVR, negative P waves in lead I and/or II, very low (<0.1 mV) amplitude in an isolated peripheral lead, or abnormal R progression in the precordial leads. We analyzed 838 ECGs and identified 37 ECGs suspicious for electrode misplacement, from which 7 were confirmed. The frequency of ECG artifacts due to switched electrodes was 0.4% (3/739) at the outpatient clinic and 4.0% (4/99) at the intensive care unit (P = .005). In conclusion, errors in ECG performance do occur with an increasing frequency in an acute medical care setting.
authors.affiliation: Wolfson Institute of Biomedical Research, University College London, WC1E 6BT London, UK. a.rudiger@ucl.ac.uk
authors.forename: Alain
authors.initials: A
authors.lastname: Rudiger
authors.forename: Jens P
authors.initials: JP
authors.lastname: Hellermann
authors.forename: Raphael
authors.initials: R
authors.lastname: Mukherjee
authors.forename: Ferenc
authors.initials: F
authors.lastname: Follath
authors.forename: Juraj
authors.initials: J
authors.lastname: Turina
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities; D016477:Artifacts; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004562:Electrocardiography; D004566:Electrodes; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies