Incorrect Placement of the Ground Electrode in the 12-lead Electrocardiogram: Its Clinical Implications and a Simple Identification Strategy in Healthcare Fields

Abstract

  The twelve-lead electrocardiographic (ECG) examination is used in various healthcare fields, and its automatic diagnosis functions play an important role in enabling the handling of a large number of ECGs in a short period of time. Incorrect placement of the ground electrode, while rare, can happen due to human error, and can impede the automatic diagnosis functions from identifying erroneous ECG recordings. This study assessed the ECG characteristics of incorrect ground electrode placement and its clinical implications in two patients. The results showed that (1) an isoelectrical line in either lead II or III is a simple way to identify incorrect electrode placement, and that two pairs of identical limb ECGs, or one pair of identical and one pair of polarity reversed symmetric limb ECGs additionally aid in identifying such a mistake; and (2) incorrect ground electrode attachment can result in the loss of electrocardiographic information corresponding to several frontal axis directions. All healthcare staff in charge of ECG examinations should to be aware of the unique characteristics of incorrect ground electrode placement to ensure proper recording of ECGs and improve the accuracy of ECG examinations.