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(Circulation. 2000;101:2870.)
© 2000 American Heart Association, Inc.

Images in Cardiovascular Medicine

"Switched" Precordial Leads

J. Willis Hurst, MD

From the Department of Medicine, Emory University School of Medicine, Atlanta, Ga.

Correspondence to J. Willis Hurst, MD, 1462 Clifton Rd, NE, Suite 301, Atlanta, GA 30322. E-mail jhurst@emory.edu

Most physicians and technicians have, at one time or another, inadvertently "switched" the extremity leads in preparation for the recording of an ECG. This is so common that some modern ECG machines advise the operator that he or she has switched the leads.

Misplacement of the electrode positions is the most common error related to recording the chest leads. The next most common cause of error is probably switching the V₁ and V₂ electrode positions on the chest. This error is easy to make because the wires attached to the lead selector box are adjacent to each other.

During our cardiology morning report, I was shown several ECGs. Two of them were quite unusual. I could not construct the spatial direction of the mean QRS vectors; the frontal plan calculation was easily diagrammed, but the anterior-posterior direction could not be constructed. One of these tracings is shown in Figure 1. There was a tall R wave in lead V₁, a small R wave in lead V₃, and tall R waves in leads V₄ through V₆. The resultantly negative QRS complex at position V₃ was out of place. It appeared that the QRS complex in lead V₃ was more likely recorded from the V₁ position and the QRS complex in lead V₁ was recorded from the V₃ position. If this was true, how did it happen?

View larger version (110K): [in this window] [in a new window]   Figure 1. ECG showing switched chest leads V1 and V3.

I inspected the ECG machine that was used by the new night . . . [Full Text of this Article]

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