The development and validation of an early warning system to prevent the acquisition of 12-lead resting ECGs with interchanged electrode positions

- We have developed and tested a real time 12-lead ECG electrode reversion detection algorithm.
- The algorithm detects limb electrode and chest electrode interchanges.
- The performance has been tested with a representative database of over 18,000 hospital ECGs.
- Single reversals are detected with an average specificity of 99.8%.
- Applying the algorithm would reduce the number of ECGs with electrode reversals by 80%.
- The number of false alerts given to the technician is only one per 70 ECGs taken.

BackgroundA fraction of routine resting ECG's are taken with electrode positions interchanged, leading to possible clinical misinterpretation.ObjectiveDevelop and test a method to detect and prevent electrode reversals at the electrocardiograph before the ECG is acquired.MethodThe algorithm is based on QRS axis and P amplitudes for limb electrode reversals, and P-Q-RS amplitude distances to detect chest electrode reversals. The evaluation method involved a large (> 18,000) hospital database for which serial ECG's were available and was based on simulated juxtapositions.ResultsThe 7 most common lead reversals could be detected with a specificity of 99.8% per type and an average sensitivity of 90%, excluding LA-LL reversal (22% sensitivity).DiscussionResults are similar to retrospective studies that used smaller, more homogeneous datasets.ConclusionThe early warning system reduces the ECG's recorded with reversal by 80%, at the price of a modest false alert rate of 1.4%.