ECG lead misplacement by colour – What difference does it make?

Abstract

Background: Coronary artery disease (CAD) and deaths from CAD are on the increase in sub-Saharan Africa. As a result the number of ECGs being recorded is increasing. Lead misplacement is associated with changes in the ECG recording, some of which can mimic significant clinical conditions. A large body of research on limb lead misplacement is available. However I have not been able to source any research on lead misplacement in which misplacement has occurred according to the colour of the leads.
Objectives: To investigate the differences in the 12-lead ECG which occur when lead misplacement by their colour has occurred.
Materials and Methods: A series of 12-lead ECGs were recorded on a healthy male volunteer. These included an ECG in which all leads were correctly attached followed by ECGs with lead misplacement based on their colour (Red: right arm – V1, Yellow: left arm – V2, Green: left leg – V3, Black: right leg – V5).
Results: The most dramatic differences occurred when the yellow leads (left arm and V2) were misplaced as well as when the green leads (left leg and V3) were misplaced.
Conclusion: It is important that those responsible for recording and interpreting ECGs are familiar with all types of lead misplacement including those in which the misplacement by the colour of the leads has occurred. A larger study should be performed to determine the consistency of these changes or the presence of others, not previously recorded.

Keywords: ECG, lead, misplacement, colour.