Evaluation of changes in standard electrocardiographic QRS waveforms recorded from activity-compatible proximal limb lead positions

Pahlm, Olle; Haisty, Wesley K.; Edenbrandt, Lars; Wagner, Nancy B.; Sevilla, Dorina C.; Selvester, Ronald H.; Wagner, Galen S.

doi:10.1016/0002-9149(92)91315-u

Cited by 55 publications

(29 citation statements)

References 7 publications

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“…Consequently, the former cannot be used as a substitute for, or for comparison with, the standard resting 12-lead ECG. 50 Blood pressure should be measured periodically throughout the test, at least at every stage and more frequently in some high-risk patients, as well as in recovery during ECG monitoring. Patients should be questioned about symptoms periodically during and after exercise, and for research and comparison purposes, an angina scale, dyspnea scale, and/or rating of perceived exertion should be used.…”

Section: Exercise Mode and Protocol Selectionmentioning

confidence: 99%

Assessment of Functional Capacity in Clinical and Research Settings

Arena¹,

Myers²,

Williams³

et al. 2007

Circulation

510

219

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Section: Exercise Mode and Protocol Selectionmentioning

confidence: 99%

Assessment of Functional Capacity in Clinical and Research Settings

Arena¹,

Myers²,

Williams³

et al. 2007

Circulation

510

219

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“…However, one study has shown that electrode placement along the limbs can affect ECG voltages and durations, most importantly in the limb leads. 81 Whether these differences are large enough to alter routine diagnostic criteria, such as voltage for left ventricular hypertrophy or Q-wave duration for inferior infarction, is unknown. Further confounding this situation is the variability in electrode placement that might have been present during the actual derivation of the diagnostic criteria involved, because studies during the past several decades have rarely described electrode placement in detail.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence exists that different placement of electrodes on the limbs can alter the ECG, a phenomenon that appears to be more marked with respect to the left arm electrode. 81 Therefore, reevaluation of the magnitude of changes due to variation in limb electrode placement in clinical practice is required, as discussed below. Six electrodes are placed on the chest in the following locations: V 1 , fourth intercostal space at the right sternal border; V 2 , fourth intercostal space at the left sternal border; V 3 , midway between V 2 and V 4 ; V 4 , fifth intercostal space in the midclavicular line; V 5 , in the horizontal plane of V 4 at the anterior axillary line, or if the anterior axillary line is ambiguous, midway between V 4 and V 6 ; and V 6 , in the horizontal plane of V 4 at the midaxillary line.…”

Section: Recommendationmentioning

confidence: 99%

“…More recent applications of the Mason-Likar monitoring position place the arm electrodes over the outer clavicles. 81,106 The precordial electrodes are placed in the standard positions. An alternative modification of limb lead placement developed for bicycle ergometry applies the arm electrodes to the upper outer arm and the leg electrodes to the anterior iliac crest.…”

Section: Kligfield Et Al Standardization and Interpretation Of The Ecmentioning

confidence: 99%

“…At present, manufacturers should be encouraged to make this display available as a routine option in new electrocardiographs. 81,112 Motion artifact of the limbs is a particular problem for routine recording in neonates, infants, and young children, in whom torso leads are sometimes used; the clinical significance of the resulting differences remains to be established. …”

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confidence: 99%

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Recommendations for the Standardization and Interpretation of the Electrocardiogram

Kligfield¹,

Gettes²,

Bailey³

et al. 2007

Circulation

Self Cite

530

152

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Abstract-This statement examines the relation of the resting ECG to its technology. Its purpose is to foster understanding of how the modern ECG is derived and displayed and to establish standards that will improve the accuracy and usefulness of the ECG in practice. Derivation of representative waveforms and measurements based on global intervals are described. Special emphasis is placed on digital signal acquisition and computer-based signal processing, which provide automated measurements that lead to computer-generated diagnostic statements. Lead placement, recording methods, and waveform presentation are reviewed. Key Words: AHA Scientific Statements Ⅲ electrocardiography Ⅲ computers Ⅲ diagnosis Ⅲ electrophysiology Ⅲ intervals Ⅲ potentials Ⅲ tests I n the century since the introduction of the string galvanometer by Willem Einthoven, 1 the electrocardiogram (ECG) has become the most commonly conducted cardiovascular diagnostic procedure and a fundamental tool of clinical practice. 2,3 It is indispensable for the diagnosis and prompt initiation of therapy in patients with acute coronary syndromes and is the most accurate means of diagnosing intraventricular conduction disturbances and arrhythmias. Its interpretation may lead to the recognition of electrolyte abnormalities, particularly of serum potassium and calcium, and permit the detection of some forms of genetically mediated electrical or structural cardiac abnormalities. The ECG is routinely used to monitor patients treated with antiarrhythmic and other drugs, in the preoperative assessment of patients undergoing noncardiac surgery, and in screening individuals in high-risk occupations and, in some The American Heart Association, the American College of Cardiology, and the Heart Rhythm Society make every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. Copies: This document is available on the World Wide Web sites of the American Heart Association (www.americanheart.org) and the American College of Cardiology (www.acc.org). A single reprint is available by calling 800-242-8721 (US only) or writing the American Heart Association, Public Information, 7272 Greenville Ave, Dallas, TX 75231-4596. Ask for reprint No. 71-0389. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@wolterskluwer.com.Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.americanheart.org/presenter.jhtml? Identifierϭ4431. A link to the "Permission Request Form" appears on the right side of the page.© 2007 American...

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Lead Systems

Macfarlane¹

2011

Basic Electrocardiology

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Evaluation of changes in standard electrocardiographic QRS waveforms recorded from activity-compatible proximal limb lead positions

Cited by 55 publications

References 7 publications

Assessment of Functional Capacity in Clinical and Research Settings

Assessment of Functional Capacity in Clinical and Research Settings

Recommendations for the Standardization and Interpretation of the Electrocardiogram

Lead Systems

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