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Modified torso vs distal limb electrode placement for performing ECGs in children: A method comparison study.
Ivor B Asztalos1, Amanda S Artis2, Alexis E Zavez2
1Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, PA, USA.
Journal of Electrocardiology
|October 23, 2024
Summary
Placing limb electrodes on the torso during pediatric electrocardiograms (ECGs) alters measurements, especially in shorter children. This modified ECG placement may lead to misinterpreting heart abnormalities.
Area of Science:
- Pediatric Cardiology
- Electrocardiography
- Biomedical Engineering
Background:
- Standard electrocardiograms (ECGs) in children often use torso limb electrode placement.
- The impact of this modified pediatric ECG configuration on diagnostic accuracy is not well-studied.
Purpose of the Study:
- To compare standard limb lead ECGs with torso limb lead ECGs in healthy children.
- To evaluate how children's height affects agreement between these two ECG configurations.
Main Methods:
- 185 children (5-18 years) had two 12-lead ECGs: one standard, one with torso limb leads.
- Agreement for 17 ECG parameters was assessed using Bland-Altman plots and height-dependent error analysis.
Main Results:
- Torso placement shifted QRS and P wave axes rightward and altered precordial amplitudes.
- PR interval and QRS duration showed agreement, but QTc intervals had wide limits of agreement.
- Measurement errors were larger in shorter children and increased with parameter magnitude.
Conclusions:
- Modified torso limb electrode placement significantly alters pediatric ECG signals.
- This can lead to misclassification of cardiac abnormalities, particularly in shorter children or those near normal limits.
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