Recognition of electrocardiographic electrode misplacements involving the ground (right leg) electrode

Detecting ECG Limb Lead-wire Interchanges Involving the Right Leg Lead-wire

“…could find for right arm and leg interchange by Haisty [5]. Our algorithm detects both arm interchanges with right leg.…”

“…Since the data set was selected as two separate groups, a positive and control group, PPV was estimated from SE, SP and prevalence (PREV) [6]. For comparison, the Haisty algorithm for RA-RL lead interchange was tested on the same dataset [5].…”

“…As part of the validation, the automated algorithm presented here was compared to the Haisty algorithm for RA-RL interchange [5].…”

Electrocardiographic Electrode Misplacement, Misconnection, and Artifact

“…Right/left reversal involves switching either the arm or the leg electrodes. Arm reversal (right arm/left arm) is probably the most common electrocardiographic electrode misconnection; although it is reasonable to assume that leg reversal (right leg/left leg) would be equally common (1)(2)(3). Due to the function of the right leg electrode as a ground wire, and the distance of the leg electrodes from the heart, reversal of the leg electrodes does not cause distinguishable changes on the ECG; the potentials at each leg are essentially the same (4).…”

Recommendations for the Standardization and Interpretation of the Electrocardiogram

“…As a corollary, the ECG in a patient with mirror-image dextrocardia may be "normalized" by purposely reversing the left and right arm lead wires and using mirror-image right-sided precordial leads. Transposition of the right arm and right leg lead wires is also easy to recognize, because lead II now records the nearly zero potential difference that exists between the 2 legs (140,141), which results in very low amplitude only in lead II, with inverted symmetry between standard lead I and lead III. Transposition of the left arm and left leg lead wires is more difficult to recognize because the main effects are an often subtle shift in axis and inversion of lead III; it can be suspected from changes in P-wave morphology in the limb leads (138), although the specificity of this approach has been challenged (137).…”