Inter-lead correlation analysis for automated detection of cable reversals in 12/16-lead ECG

Detection of Unicolor ECG Electrode Reversals in Standard 12-Lead ECG

“…This section addresses the method for simulation of unicolor electrode reversals, as well as the new methods for improving the detection of two unicolor lead reversals (RC1, NC5). They have been proposed in response to the observed performance drop ( Table 1), considering that the basic LQMLib algorithm [10] has not been designed to detect any interchanges between limb and chest electrodes, including unicolor ones.…”

“…The LQMLib algorithm for detection of chest lead reversals is based on the inter-lead ECG waveform similarities within 4s, following the normal progression of the cardiac vector projection on the horizontal plane (V1-V6) [10]. It estimates a square matrix rLS(6×6), containing the inter-lead correlation coefficients between all pairwise combinations of leads within the standard set: LS = [V1, V2, V3, V4, V5, V6] - Figure 1.…”

“…Numerous approaches were proposed for the automated detection of limb ECG electrode reversals: -Left arm (L) and left leg (F) reversal was examined by P wave amplitude [2] and QRS, P-axes [3]; -Right arm (R) and right leg (N) reversal was detected by observing flat line ECG in lead II [4]; -Various L/R/F/N reversals were detected using the direction of P-loop inscription and/or frontal P-axis [5]; frontal QRS-axis [6]; lead reconstruction using redundancy of information in 8 independent leads [7]; morphological measurements of QRS, P-wave amplitudes, frontal axis and clockwise vector loop rotation, combined with redundancy features [8]; maximal and minimal QRS, T-wave voltages in leads I, II, III [9]; correlation coefficients, comparing limb leads to V6 [10]; gathering the features described in [3] and [7] for a more robust and accurate performance [11].…”

“…Fewer studies proposed solutions for detection of chest lead reversals. Among the mentioned publications for limb leads, only four addressed chest leads reversals: -5 reversals of adjacent leads (V1/V2, V2/V3, V3/V4, V4/V5 and V5/V6) were analysed in [3]; -9 reversals, including 5 adjacent leads, V1/V3, V4/V6, V4/V5/V6/V1/V2/V3 and V6/V5/V4/V3/V2/V1 were evaluated in [7]; -7 reversals, including 5 adjacent leads, V1/V3 and V4/V6 were handled in [8]; -15 reversals, including all possible pairwise V1-V6 swaps were tested in our previous study [10]. Recently, Joshi et al [12] presented an interesting case of a chest pain patient with an initial ECG demonstrating ST-segment elevation in the inferior leads, whereas the subsequent ECG showed ST elevation in the chest leads.…”

False Alarm Reduction in Self-Care by Personalized Automatic Detection of ECG Electrode Cable Interchanges

“…Using linear support vector machine, these authors found a sensitivity and a specificity of 56.5% and 99.9% for detecting seven precordial cable interchanges (V1-V2, V1-V3, V2-V3, V3-V4, V4-V5, V4-V6, and V5-V6), and respectively 93.8% and 99.9% for limb cable interchanges, but they did not consider the LA-LL interchange which requires serial ECGs in their opinion [15]. Jekova et al considered in their study, based on interlead correlation, four LA, RA and LL reversals (RA-LA, LL-RA, clockwise and counter-clockwise), and the 15 pairwise precordial leads [16]. eir results in three test sets vary from 91.7% to 97.6% of sensitivity and from 99.2% to 99.7% of specificity for RA-LA and LL-RA interchanges.…”