Detection of Unicolor ECG Electrode Reversals in Standard 12-Lead ECG

Irena Jekova1, Remo Leber2, Vessela Krasteva1, Ramun Schmid2
1Institute of Biophysics and Biomedical Engineering, Bulgarian Academy of Sciences, 2Schiller AG


Lead reversals, reported in 0.4-4% of all standard 12-lead ECGs, can lead to erroneous diagnosis and wrong therapy decisions due to simulated false or missed ECG abnormalities. Although the interchange between 12-lead ECG cables with matching colors is likely an occasionally occurring scenario, the effect of this problem has not been addressed in the literature so far. The aim of this study is to test the ability of a commercial lead quality monitoring library (LQMLib, Schiller AG) to detect reversals between limb and chest unicolor ECG electrodes and to propose methods for improvements, where necessary. We performed a retrospective analysis of 1332 12-lead ECGs collected at the Emergency Department of the University Hospital, Basel via Schiller CS-200 Excellence device. We assumed correct electrode placement during ECG acquisition and simulated 7 unicolor electrode reversals, including: