Electrocardiogram Electrode Positioning on the Back During Echocardiography: An Exploratory Cross-Sectional Study.
Satoshi Yamashita1, Takeji Saitoh2, Keisuke Iguchi1
1Department of Cardiology, Hamamatsu University School of Medicine, Hamamatsu, JPN.
Cureus
|May 13, 2024
Summary
Electrocardiogram (ECG) electrode placement on the back may improve cardiac cycle interpretation during echocardiography. This alternative positioning reduces respiratory interference, enhancing diagnostic accuracy for ECG rhythms and phases.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Electrocardiogram (ECG) interpretation can be challenging due to baseline fluctuations and electrode dislodgement, leading to potential misinterpretation of cardiac rhythms and cycles.
- Conventional ECG electrode placement on the anterior chest can be affected by respiratory variations, particularly during procedures like echocardiography.
- Investigating alternative electrode placements is crucial to improve ECG signal quality and diagnostic reliability.
Purpose of the Study:
- To compare wave amplitudes and respiratory variations between conventional anterior ECG electrode placement and an alternative posterior placement.
- To evaluate the efficacy of back-side ECG electrode positioning in mitigating respiratory artifacts during echocardiography.
Main Methods:
- Echocardiography was performed on 85 patients in the left lateral position.
- ECG electrodes were placed on both the anterior chest (right clavicle, left clavicle, left lateral abdomen) and the posterior torso (right clavicle, right upper posterior iliac spine, left upper posterior iliac spine).
- Measurements included ECG amplitudes and respiratory variations (BF-breath values).
Main Results:
- While anterior electrode placement yielded greater overall ECG amplitudes, posterior placement resulted in significantly smaller respiratory variations (BF-breath: 6.0 pixels vs. 10.5 pixels, p<0.05).
- The P wave amplitude normalized by respiratory variation was higher with posterior placement (2.8 vs. 1.8, p<0.05).
- No significant difference was observed in the QRS amplitude normalized by respiratory variation between the two placements (15.0 vs. 16.3, p=ns).
Conclusions:
- Placing ECG electrodes on the patient's back offers a viable alternative to anterior placement, particularly during echocardiography.
- Posterior electrode positioning effectively reduces respiratory-induced artifacts, thereby minimizing the risk of misinterpreting ECG rhythms and cardiac cycle phases.
- This technique can enhance the accuracy and reliability of ECG monitoring in specific clinical scenarios.
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