How to accurately record a 12-lead ECG

RATIONALE AND KEY POINTS: The 12-lead electrocardiogram (ECG) is an important tool in the diagnosis of heart disease. An accurate recording is essential because errors in electrode placement or in the attachment of connecting cables can produce ECG changes that mimic heart disease. This 'How to' article describes the procedure for obtaining an accurate ECG recording, and outlines some of the issues that might lead to errors and inaccuracies. • A 12-lead ECG is recorded by placing ten electrodes on the surface of the body: four on the limbs and six across the precordium. • A high-quality ECG recording requires good electrode contact and appropriate skin preparation. • Common issues that might result in errors and inaccuracies during ECG recordings include misplacement of the precordial electrodes, the effect of female breast tissue, and transposition of the connecting cables. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when recording a 12-lead ECG. • How you could use this information to educate your patients and colleagues on the procedure for accurately recording a 12-lead ECG.