Torso mounted electrocardiographic electrodes for routine clinical electrocardiography

doi:10.1016/S0022-0736(79)80010-2

Journal of Electrocardiology

Volume 12, Issue 4, 1979, Pages 403-406

https://doi.org/10.1016/S0022-0736(79)80010-2 Get rights and content

Summary

An easily applicable lead system similar to that proposed by Mason and Likar in 1966 for stress electrocardiography provides quantitative and qualitative electrocardiographic information and diagnoses similar to those derived from the “standard” lead system using only torso placement of ten electrodes.

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Cited by (14)

Assessment of a widely applicable torso ECG in acute coronary syndrome
2021, Indian Heart Journal
Citation Excerpt :
This is possible if a vest or a pad with pre-embedded electrodes (in torso positions) and a ECG recording device is worn by the patient obviating the need of training or skill on the part of patients or relatives. Prior attempts at torso electrode positions were abandoned for lack of accuracy.3–8 We used novel torso electrode positions and validated the new T-ECG recordings against C-ECG with special focus on ACS.
The time from symptom onset to arrival at healthcare facility, and door to reperfusion time in treatment of acute coronary syndrome (ACS) can be improved significantly if the patient or the relatives can record a 12-lead ECG at home and transmit it to the physician for prompt interpretation. To make this widely applicable, the 12-lead ECG recording device has to be simple and user friendly. In this regard, torso ECG (T-ECG) electrode positions that are less cumbersome than the conventional ECG (C-ECG) electrode positions are an alternative worthy of consideration.
and setting: To study the utility of T-ECG versus C-ECG in ACS patients.
and intervention: We proposed torso electrode positions in which upper limb electrodes were placed in the respective deltopectoral grooves below the lateral end of the clavicle; the right lower limb electrode was placed 2 finger breadths above the umbilicus and the left lower limb electrode, 2 finger breadths to the left of the umbilicus. We then studied the ECGs recorded, to ascertain whether T-ECGs miss or over-diagnose ACS changes. Twelve lead ECGs were recorded by both techniques (C-ECG & T-ECG) in 1361 patientsfrom the coronary care unit & out-patient department of a tertiary care hospital. A total of 1526 sets of ECGs (each set consisting of one C-ECG and one T -ECG) were read by two trained cardiologists independently and in a blinded fashion. There were 457 ECG sets from 342 patients with ACS. Of these, 116 ECG sets from 112 patients of anterior infarction who had changes restricted to precordial leads were excluded. Finally, 341 ECG sets from 230 patients with ACS and 324 sets of patients diagnosed to be normal on C-ECG were considered for the purpose of this study.
All 341 ECG sets from the 230 patients of ACS diagnosed by C-ECG were correctly diagnosed by T-ECG (100% sensitivity) and all 324 normal ECGs on C-ECG were also identified as normal on T-ECG (100% specificity). Of the ACS ECGs, ST elevation was seen in 234 ECGs and ST depressions 154 ECGs. The localizations of ST elevation and ST depression were also accurately diagnosed by the T-ECG.
The ECG recorded by our novel proposed torso electrode positions is comparable to a conventional ECG for the diagnosis of ACS.
Comparison of the spatial QRS-T angle derived from digital ECGs recorded using conventional electrode placement with that derived from Mason-Likar electrode position
2016, Journal of Electrocardiology
Citation Excerpt :
We too observed that the net QRS and T amplitudes were smaller in lead I and larger in lead II in Holter ECGs as compared to conventional 12-lead ECGs. While this difference in amplitude may not compromise the diagnostic utility of the modified lead system [16], Jowett et al. [17] found that the frontal plane QRS and T wave axes differed by 25% with standard and modified lead positions, with the axes being more positive with the modified lead placement; we too found higher mean frontal QRS and T axes in Holter ECGs in the present study. Though the differences in QRS and T waves axes in the sagittal and frontal planes differed significantly between the conventional 12 leads and Holter ECGs, we found that the difference in the spatial QRS-T angle, though statistically significant, was relatively small in magnitude.
The spatial QRS-T angle is ideally derived from orthogonal leads. We compared the spatial QRS-T angle derived from orthogonal leads reconstructed from digital 12-lead ECGs and from digital Holter ECGs recorded with the Mason-Likar (M-L) electrode positions.
Orthogonal leads were constructed by the inverse Dower method and used to calculate spatial QRS-T angle by (1) a vector method and (2) a net amplitude method, in 100 volunteers.
Spatial QRS-T angles from standard and M-L ECGs differed significantly (57° ± 18° vs 48° ± 20° respectively using net amplitude method and 53° ± 28° vs 48° ± 23° respectively by vector method; p < 0.001). Difference in amplitudes in leads V4–V6 was also observed between Holter and standard ECGs, probably due to a difference in electrical potential at the central terminal.
Mean spatial QRS-T angles derived from standard and M-L lead systems differed by 5°–9°. Though statistically significant, these differences may not be clinically significant.
Does modifying electrode placement of the 12 lead ECG matter in healthy subjects?
2011, International Journal of Cardiology
Citation Excerpt :
Moreover, in clinical practice the limbs are sometimes inaccessible. To avoid these problems limb electrodes in recumbent and resting subjects are often placed on the torso with a variety of configurations [3–8]. Such modification should not alter the ECG waveform in the transverse plane leads, because only the limb electrodes have been moved.
Limb electrodes for the 12 lead ECG are routinely placed on the torso during exercise stress testing or when limbs are clinically inaccessible. It is unclear whether such electrode modification produces ECG changes in healthy male or female subjects that are clinically important according to the 2009 AHA, ACCF, HRS guidelines. We therefore measured whether ECG modification produced clinically important or false positive ECG changes e.g., appearance of Q waves in leads V_1–3, ST changes greater than 0.1 mV, T wave changes greater than 0.5 mV (frontal plane) or 1 mV (transverse plane), QRS axis shifts or alterations to QTc/P–R/QRS intervals.
The 12 lead ECG was measured in 18 healthy and semi-recumbent subjects using the standard and Takuma modified limb placements.
In the frontal plane we demonstrate that the modification of limb electrode placement produces small Q, R and T wave amplitude and QRS axis changes that are statistically but not clinically significant. In the transverse plane it produces no statistically or clinically significant changes in the ECG or in ST segment morphology, P–R, QRS or QTc intervals.
We provide better and more robust evidence that routine modification of limb electrode placement produces only minor changes to the ECG waveform in healthy subjects. These are not clinically significant according to the 2009 guidelines and thus have no effect on the clinical specificity of the 12 lead ECG.
Intraindividual variability in electrocardiograms
2008, Journal of Electrocardiology
Citation Excerpt :
However, often a baseline (resting) ECG is taken before the exercise test using the same lead positions. Mason et al,33 and later on also Diamond et al,34 concluded that ECGs recorded with this system can be compared with standard ECGs. Others, however, reported profound amplitude and waveform changes.35-40
The electrocardiogram (ECG) can be affected by intraindividual variations from various sources that may confuse the diagnosis of the underlying cardiac condition and impair the accuracy of ECG interpretation. Intraindividual variability is a hindrance in serial ECG analysis, where ECGs of the same individual, but taken at different times, are compared. Two sources of intraindividual variability can be distinguished as follows: variability related to the technical circumstances during ECG recording (technical sources) and nonpathologic biologic variability (biological sources). Among the technical sources, variation in electrode positioning between recordings is the most confusing. Of the biological sources, respiratory variations are effective at any time scale, but the most important are age and weight that work on prolonged time scales. Technical problems are best prevented by rigorously sticking to a standard acquisition protocol. Criteria can be adapted to changing circumstances (age, weight), and by computer modeling, it may be possible to correct the ECG diagnosis for some sources of intraindividual variability.
Comparability of the standing and supine standard electrocardiograms and standing sitting and supine stress electrocardiograms
2006, Journal of Electrocardiology
The aim of this study was to evaluate whether change in the patients' position during the electrocardiogram (ECG) recording alters the various components of the ECG curve. Concerns whether ECGs in medically compromised patients recorded in a sitting position should be considered “standard” tracings and whether ECGs recorded in the supine and standing positions and ECGs recorded in different positions in the Exercise Laboratory are interchangeable provided the impetus for this study. The ECG was recorded in the supine and standing positions in 10 patients using standard electrode placement and in the sitting, standing, and supine positions in 16 patients using the Mason-Likar electrode system. Comparisons of sums of P waves and QRS complexes of various combinations of ECG leads from recordings in different positions and amplitudes of Q, R, and S waves of all 12 ECG leads revealed stability in the standard and stress ECGs, although few statistically significant but minor changes were noted in some comparisons, which, however, could not be expected to have any diagnostic significance. Comparison of standard ECGs recorded in patients in the supine and standing positions and stress ECGs recorded in the sitting, standing, and supine positions are interchangeable; this should allay concerns about recording the standard ECG in unconventional positions and may facilitate and make more cost-effective ECG recording in busy outpatient clinic environments.
Comparison of standard 12-lead and modified exercise electrocardiograms
1990, The American Journal of Cardiology

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¹: The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. § 1734 solely to indicate this fact.

^*: Formerly medical students, Brown University Program in Medicine. Presently interns at Mt. Auburn Hospital, Cambridge, MA and the Memorial Hospital, Pawtucket, Rhode Island respectively.

^†: Presently a medical student at Brown University Program in Medicine.

^**: Chief, Cardiology Division, The Memorial Hospital, Pawtucket, R.I., and Professor of Medicine, Brown University.

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Torso mounted electrocardiographic electrodes for routine clinical electrocardiography1

Summary

Am Heart J

Am Heart J

Amer J Card

Am Heart J