Identification of 4th intercostal space using sternal notch to xiphoid length for accurate electrocardiogram lead placement.
OBJECTIVE
Precordial ECG lead placement is difficult in obese patients with increased chest wall soft tissues due to inaccurate palpation of the intercostal spaces. We investigated whether the length of the sternum (distance between the sternal notch and xiphoid process) can accurately predict the location of the 4th intercostal space, which is the traditional location for V1 lead position.


METHODS
Fifty-five consecutive adult chest computed tomography examinations were reviewed for measurements.


RESULTS
The sternal notch to right 4th intercostal space distance was 67% of the sternal notch to xiphoid process length with an overall correlation of r=0.600 (p<0.001).


CONCLUSIONS
The above measurement may be utilized to locate the 4th intercostal space for accurate placement of the precordial electrodes in adults in whom the 4th intercostal space cannot be found by physical exam.
Department of Medical Imaging, University of Arizona Medical Center, 1501N. Campbell Ave. PO Box 245067, Tucson, AZ. Electronic address: kevin.day.md@gmail.com.
Kevin
K
Day
Department of Medical Imaging, University of Arizona Medical Center, 1501N. Campbell Ave. PO Box 245067, Tucson, AZ.
Isabel
I
Oliva
Department of Medical Imaging, University of Arizona Medical Center, 1501N. Campbell Ave. PO Box 245067, Tucson, AZ.
Elizabeth
E
Krupinski
Department of Medicine, University of Arizona Medical Center, 1501N. Campbell Ave. PO Box 245037, Tucson, AZ.
Frank
F
Marcus
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D059925:Anatomic Landmarks / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015203:Reproducibility of Results; D012272:Ribs / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013249:Sternum / Q000000981:diagnostic imaging*; D014989:Xiphoid Bone / Q000000981:diagnostic imaging
ECG lead placement; Imaging; Intercostal space; Sternal notch