Background/Aims Electrode misplacement appears to be a common finding during 12-lead electrocardiography and there are numerous potential causes and effects. This article aims to identify the frequency of electrode misplacement during electrocardiography, examine the effect this may have on patient safety and review the causes of misplacement. Methods A systematic literature review of current primary research was conducted across three electronic healthcare databases using the EBSCOhost platform. Findings Electrode misplacement is a very common finding, particularly in acute healthcare areas. There are many causes, some intentional but most are unintentional in nature. Electrode misplacement affects the electrocardiograph morphology substantially, having the potential to alter the diagnosis that could lead to unnecessary patient harm. Conclusion: It is of great importance for electrocardiograms to be recorded accurately and correctly to preserve patient safety. This could be achieved through structured training facilitated by nurse specialists.