The effect of modified limb electrode positions on electrocardiographic wave amplitudes

Mofidied limb electrode positions are often used in studies which require the recording of rest and exercise ECGs, whereby the arm electrodes are placed at the infraclavicular fossae and the left lef electrode on the left lower abdomen. The effect of the modified limb electrode positions on electrocardiographic waveforms was investigated in 68 supine adult male subjects at rest. The modification produced profound amplitude and waveform changes in the frontal plane ECG leads. The QRS axis shifted on the average by 16 degrees towards a more vertical position with considerable individual variation. Concomitant with the QRS axis shift, the R wave amplitude decreased in leads I and a VL and increased in leads II, III, and aVF. The S wave amplitude increased in leads III and aVF and decreased in lead III. The P and T wave amplitude changes were in a direction similar to those observed for the R waves: a reduction of the amplitude in aVL and an increase in II, III and aFV. Of importance to exercise ECG interpretation are the ST segment waveform changes: The ST slope decreased in aVL and increased in leads II, III and aVF. Waveform changes in the chest leads caused by the modification were less important although statistically significant. These systematic changes in recorded ECG waveforms arise from changes directions and strength of the lead vectors of the six frontal plane leads. Large inter-individual variations in the magnitude of the changes produced by modification of the limb electrode positions prevent effective systematic correction of the distortions by means of a universal lead transformation.