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Common source of miscalculation and misclassification of P-wave negativity and P-wave terminal force in lead V1

Maria Uggen Rasmussen1, Andreas Fabricius-Bjerre1, Preman Kumarathurai1

  • 1Department of Cardiology, Copenhagen University Hospital of Bispebjerg, Bispebjerg Bakke 23, 2400 Copenhagen, Denmark.

Journal of Electrocardiology
|February 5, 2019
PubMed

Insights

Incorrect placement of the V1 ECG electrode significantly alters P-wave terminal force (PTF) and deep terminal negativity (DTN) markers. High V1 electrode placement can falsely indicate left atrial abnormality, impacting atrial fibrillation and stroke risk assessment.

Area of Science:

  • Cardiology
  • Electrocardiography
  • Biomedical Engineering

Background:

  • P-wave terminal force (PTF) and deep terminal negativity (DTN) are key ECG indicators of left atrial abnormality, linked to atrial fibrillation and stroke.
  • Incorrect placement of the precordial lead V1, particularly higher than the standard fourth intercostal space, is a common issue that can affect these ECG markers.
  • The quantitative impact of V1 electrode misplacement on PTF and DTN has not been previously studied.

Purpose of the Study:

  • To evaluate the influence of precordial electrode V1 misplacement on PTF and DTN measurements.
  • To quantify the changes in these ECG markers when V1 is placed at higher intercostal spaces.

Main Methods:

  • 12-Lead ECGs were recorded from 29 healthy volunteers.
  • The V1 electrode was positioned in the fourth, third, and second intercostal spaces for each subject.
  • Statistical analysis included Dunnett's post-hoc test for continuous variables and Fischer's exact test for categorical variables.

Main Results:

  • High V1 electrode placement (second intercostal space) resulted in a >3-fold increase in PTF compared to the standard position (fourth intercostal space).
  • Deep terminal negativity (DTN) significantly increased from 0% at the fourth intercostal space to 28% at the second intercostal space.
  • P-wave morphology in V1 shifted from predominantly positive/biphasic to 90% negative with high V1 placement, while PR and P-wave durations remained unchanged.

Conclusions:

  • Elevated V1 electrode placement significantly alters PTF and DTN values.
  • Misplacement of the V1 electrode can lead to inaccurate assessments of left atrial abnormality.
  • Standardized ECG electrode placement is crucial for reliable interpretation of PTF and DTN.
Abstract

Keywords:
Deep terminal negativityElectrocardiogramElectrode placementP-waveP-wave terminal forceV1 electrode

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