The development and validation of an early warning system to prevent the acquisition of 12-lead resting ECGs with interchanged electrode positions

J Electrocardiol. 2014 Nov-Dec;47(6):794-7. doi: 10.1016/j.jelectrocard.2014.08.015. Epub 2014 Aug 23.

Abstract

Background: A fraction of routine resting ECG's are taken with electrode positions interchanged, leading to possible clinical misinterpretation.

Objective: Develop and test a method to detect and prevent electrode reversals at the electrocardiograph before the ECG is acquired.

Method: The algorithm is based on QRS axis and P amplitudes for limb electrode reversals, and P-Q-RS amplitude distances to detect chest electrode reversals. The evaluation method involved a large (>18,000) hospital database for which serial ECG's were available and was based on simulated juxtapositions.

Results: The 7 most common lead reversals could be detected with a specificity of 99.8% per type and an average sensitivity of 90%, excluding LA-LL reversal (22% sensitivity).

Discussion: Results are similar to retrospective studies that used smaller, more homogeneous datasets.

Conclusion: The early warning system reduces the ECG's recorded with reversal by 80%, at the price of a modest false alert rate of 1.4%.

Keywords: Automatic detection; ECG; Electrocardiogram; Electrode interchange; Electrode misplacement; Electrode reversal.

Publication types

  • Evaluation Study
  • Validation Study

MeSH terms

  • Algorithms
  • Arrhythmias, Cardiac / diagnosis*
  • Clinical Alarms*
  • Computer Systems
  • Diagnosis, Computer-Assisted / methods*
  • Diagnostic Errors / prevention & control*
  • Electrocardiography / instrumentation*
  • Electrocardiography / methods*
  • Electrodes
  • Female
  • Humans
  • Male
  • Pattern Recognition, Automated / methods
  • Reproducibility of Results
  • Sensitivity and Specificity