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Europace Advance Access published online on October 10, 2007
Europace, doi:10.1093/europace/eum198
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

REVIEW

Incorrect electrode cable connection during electrocardiographic recording

Velislav N. Batchvarov*, Marek Malik and A. John Camm

Division of Cardiac and Vascular Sciences, St George’s University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK

Incorrect electrode cable connections during electrocardiographic (ECG) recording can simulate rhythm or conduction disturbance, myocardial ischaemia and infarction, as well as other clinically important abnormalities. When only precordial or only limb cables, excluding the neutral cable, have been interchanged the waveforms in the different leads are re-arranged, inverted, or unchanged, whereas the duration of intervals is not changed. The mistake can be recognized by the presence of unusual P–QRS patterns (e.g. negative P–QRS in lead I or II, positive in lead AVR, P–QRS complexes of opposite direction in leads I and V6, etc.), change in the P–QRS axis, or abnormal precordial QRS–T wave progression. Interchange of limb cables with the neutral cable distorts Wilson’s terminal and the morphology of all precordial and unipolar limb leads. The telltale sign of the mistake is the presence of (almost) a flat line in lead I, II or III. Interchange of even one of the limb cables, except for the neutral cable, with a precordial cable distorts the morphology of most leads and leaves not more than one lead (I, II, or III) unchanged. Computerized algorithms for detection of lead misplacement, such as those based on artificial neural networks, or on correlation between original and reconstructed leads, have been developed.

Key Words: Electrocardiogram, Electrocardiographic lead, Lead misplacement, Central terminal, Wilson’s terminal

* Corresponding author. Tel: +44 208 725 5909; fax: +44 208 767 7141. E-mail address: vbatchva{at}sgul.ac.uk

Manuscript submitted 5 July 2007. Accepted after revision 22 August 2007.


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