Key result
Variation in electrode placement caused the largest morphological changes in precordial leads V2 and V3, demonstrating the possibility of a false diagnosis of RBBB during sinus rhythm.
Why the study?
While clinical studies have assessed the influence of electrode placement on 12 lead ECG morphology, an in silico investigation had not yet been conducted.
Does electrode placement variation influence the morphology of in silico 12-lead ECGs?
Does electrode placement variation influence the morphology of in silico 12-lead ECGs?
In silico modeling demonstrates that improper electrode placement, particularly of V2, V3, and LA, significantly alters ECG morphology and can lead to false diagnoses such as RBBB.
Risks false RBBB from V2-V3 misplacement; in silico data leave open human validation.
Introduction: Multiple clinical studies have aimed to assess the influence of electrode placement on 12 lead electrocardiogram (ECG) morphology. However, a study has not yet been conducted in silico. We therefore aim to systemically investigate the influence of electrode positioning on the morphology of the 12 lead ECG using a cardiac model of electrophysiology under both healthy sinus rhythm and right bundle branch block (RBBB). Methods: A biophysically-detailed model of ventricular electrophysiology of a single subject was used to model body surface potential maps during healthy sinus rhythm and RBBB. A systematic automatic perturbation of all electrodes from the original subject configuration was performed to replicate clinical variation. For each variation in electrode placement, the 12 lead ECG was computed under both conditions. Quantitative differences were assessed using a time-averaged normalized <tex>L₂</tex> norm. Results: The precordial leads that lie in closer proximity to the heart, primarily V2 and V3, experienced the largest morphological changes from vertical electrode movement. Morphological variation in the augmented Goldberger and Einthoven leads resulted predominantly from LA electrode placement. The possibility of a false diagnosis of RBBB during sinus rhythm due to improper electrode placement was also demonstrated.
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Gillette et al. (2021) studied Healthy sinus rhythm and right bundle branch block (n=1). Electrode placement variation vs. Original subject configuration was evaluated on Quantitative differences in 12 lead ECG morphology (time-averaged normalized L2 norm). Variation in electrode placement caused the largest morphological changes in precordial leads V2 and V3, demonstrating the possibility of a false diagnosis of RBBB during sinus rhythm.
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