Standardization of electrode placement for continuous patient monitoring: introduction of an assessment tool to compare proposed electrocardiogram lead configurations

Numerous modified electrocardiogram (ECG) lead configurations are used for continuous patient monitoring, and they often produce waveforms substantially different from the standard 12-lead ECG. Serial comparisons between modified and standard lead configurations can lead to misdiagnosis and inappropriate therapy. To address this problem, an international Lead Summit was convened in June 2010 to discuss standardizing lead configurations for patient monitoring. The present article summarizes an invited presentation at the Lead Summit where the author proposed an assessment tool to compare the clinical utility of various lead configurations to provide a framework for ongoing and future discussions. The tool (0-20 points, with 20 being the perfect score) weighs 5 factors that are clinically important including equivalency to the standard ECG (6 points), patient comfort (4 points), noise immunity (4 points), noninterference with clinical interventions (3 points), and identifiable anatomical landmarks for accurate electrode placement (3 points). Because research is lacking for some of these factors (eg, patient comfort and noise immunity), studies conducted in patients in actual clinical environments are needed to reach consensus about ideal lead configurations for patient monitoring.