AN ALTERNATIVE LIMB LEAD SYSTEM FOR ELECTROCARDIOGRAPHS IN EMERGENCY PATIENTS

It is occasionally difficult to record the standard 12-lead electrocar diograph (EGG) in emergency patients. The aim of this study was to eva luate the influence on electrocardiographic wave form recordings of mo ving the location of electrodes from the standard limb lead position t o the trunk. The participants were 10 normal subjects and 20 patients with heart disease. In the new lead system, the limb electrodes were p laced on the anterior acromial region and the anterior superior iliac spine using adhesive electrodes. Conventional 12-lead ECGs were record ed by the standard and the new lead system simultaneously in the supin e position. Wave form analysis was done by an automatic analysis progr am. Motion artifacts in the recordings were less in the new lead syste m. The a wave amplitude of the new lead system increased in leads II, III and aVF, and decreased in leads I and aVL. However, the amplitudes of each wave obtained by standard electrocardiography and the new lea d system correlated well (y = 1.008x + 2.038, r = 0.99, n = 2,880). In 99.6% of all wave forms, the differences in amplitudes were within 5% of the values of standard recordings. The average of differences in t he ST-segment was 2.6 +/- 11.4 mu V. The frontal plane QRS axis obtain ed try the new lead system showed a vertical shift of 7.8 +/- 8.5 degr ees (y = 0.94911x + 10.346, r = 0.98, n = 30). The recording errors pr oduced by the new lead system were within the permissible range of var iation. The new lead system is a reasonable alternative for recording ECGs if application of the standard lead is difficult in an emergency. (C) 1995 by W.B. Saunders Company