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The effects of electrode misplacement on clinicians’ interpretation of the standard 12-lead electrocardiogram

Bond, R.R.; Finlay, D.D.; Nugent, C.D.; Breen, C.; Guldenring, D.; Daly, M.J.


R.R. Bond

D.D. Finlay

C.D. Nugent

D. Guldenring

M.J. Daly


This study investigates how a particular incorrect electrode configuration affects the 12-lead Electrocardiogram (ECG).

A correct and an incorrect 12-lead ECG were extracted from a 192-lead BSPM. This was done for 232 BSPMs yielding 464 12-lead ECGs. The particular incorrect ECG involved displacing electrodes V1 and V2 in the second intercostal space whilst also offsetting the remaining electrodes. These ECGs were examined in two stages: (a) analysis of the effects of electrode misplacement on signal morphology and (b) analysis of how often the incorrect electrode configuration changed the diagnosis of two clinicians in a random sample of 75 patients.

According to the Root Mean Square Error (RMSE) of the difference between PQRST intervals in the correct and incorrect ECGs, lead V2 is the most affected lead (mean: 185 μV ± 82 μV), followed by lead V4 (mean: 114 μV ± 59 μV) and lead V1 (mean: 100 μV ± 47 μV). It was found that if the incorrect electrode configuration is applied, there is a 17% to a 24% chance the diagnostic interpretation will be different. Quantified using Similarity Coefficient (SC) leads V1 and V2 were found to be more alike when misplaced in the second intercostal space. The average SC between these leads when correctly placed was 0.08 (± 0.65), however when incorrectly placed, the average SC was 0.43 (± 0.3).

There is a reasonable chance this particular incorrect electrode configuration will change the diagnosis of the 12-lead ECG. This highlights the importance of developing algorithms to detect electrode misplacement along with better education regarding ECG acquisition.


Bond, R., Finlay, D., Nugent, C., Breen, C., Guldenring, D., & Daly, M. (2012). The effects of electrode misplacement on clinicians’ interpretation of the standard 12-lead electrocardiogram. European Journal of Internal Medicine, 23(7), 610-615.

Journal Article Type Article
Acceptance Date Mar 11, 2012
Online Publication Date Apr 5, 2012
Publication Date 2012-10
Deposit Date Nov 3, 2022
Journal European Journal of Internal Medicine
Print ISSN 0953-6205
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 23
Issue 7
Pages 610-615
Public URL