Detection of electrode interchange in precordial and orthogonal ECG leads

This study presents methods for automated detection of interchanged precordial and orthogonal ECG leads that may prevent from incorrect diagnosis and treatment. For precordial leads V1-V6, correlation coefficients of QRS-T patterns and time-alignment of R and S-peaks are assessed. For orthogonal leads (X,Y,Z), analysis of QRS loops in the frontal plane, a set of correlation coefficients and a time-alignment of leads are implemented. The methods are elaborated using 15-lead ECG databases - 77 healthy control recordings from PTB database (training), and the total set of 1220 ECGs in CSE database with various arrhythmias (test). The specificity (Sp) for detection of the correct precordial leads configuration (V1 to V6) is 93.5% (training) and 91% (test) and the mean sensitivity (Se) for 23 simulated most common chest electrode swaps is 95.7% (training) and 95% (test). Sp for detection of the correct orthogonal leads X,Y,Z is 98.7% (training) and 93.3% (test), while mean Se for 47 reversals of electrode couples A/I, F/H, M/E is 98.5%, equal for both training and test databases.

[1]  J. L. Willems,et al.  The diagnostic performance of computer programs for the interpretation of electrocardiograms. , 1992, The New England journal of medicine.

[2]  Alberto Herreros,et al.  Exploration of Supraventricular Conduction with respect to Atrial Fibrillation. Methodological Aspects on Selected Techniques , 2005 .

[3]  I I Christov,et al.  Electrocardiogram signal preprocessing for automatic detection of QRS boundaries. , 1999, Medical engineering & physics.

[4]  J A Milliken,et al.  Recognition of electrocardiographic left arm/left leg lead reversal. , 1997, The American journal of cardiology.

[5]  Ariel Pablos-Mendez,et al.  An agenda for action on global e-health. , 2010, Health affairs.

[6]  Marek Malik,et al.  Incorrect electrode cable connection during electrocardiographic recording. , 2007, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[7]  Xiaopeng Zhao,et al.  Automatic detection of ECG electrode misplacement: a tale of two algorithms , 2012, Physiological measurement.

[8]  Reginald T Ho,et al.  Simple Diagnosis of Limb‐Lead Reversals by Predictable Changes in QRS Axis , 2006, Pacing and clinical electrophysiology : PACE.

[9]  Jeffrey M. Hausdorff,et al.  Physionet: Components of a New Research Resource for Complex Physiologic Signals". Circu-lation Vol , 2000 .

[10]  Ferenc Follath,et al.  Electrocardiographic artifacts due to electrode misplacement and their frequency in different clinical settings. , 2007, The American journal of emergency medicine.

[11]  J A Kors,et al.  Accurate automatic detection of electrode interchange in the electrocardiogram. , 2001, The American journal of cardiology.

[12]  O. Pahlm,et al.  Detection of frequently overlooked electrocardiographic lead reversals using artificial neural networks. , 1996, The American journal of cardiology.

[13]  K. C. Ho,et al.  Use of the sinus P wave in diagnosing electrocardiographic limb lead misplacement not involving the right leg (ground) lead. , 2001, Journal of electrocardiology.

[14]  I. Hoffman,et al.  A flatline electrocardiogram in lead II is a marker for right arm/right leg electrode switch. , 2007, Journal of electrocardiology.