A proposal for a reconstruction (derivation) of V1-V6 using leads I, II, and a “sternal notch lead”: A solution to the problem of non-reproducibility of precordial leads in serial 12-lead standard electrocardiograms

Abstract

Variation of the amplitude and morphology of V1-V6 leads in serial ECGs, due to variation in the placement of V1-V6 recording electrodes, and the noncompliance in placing the V1-V6 electrodes at the recommended thoracic loci, are 2 problems which have defied solution since the advent of electrocardiography. A proposal is presented herein of a set of 3 recorded leads (conventional limb leads I and II, and a lead recorded via an electrode adjacent to the sternal notch [SNL]), aimed at reconstructing the V1-V6 leads, as a function of the 3 recorded leads, employing patient-specific and general (population) coefficients. The SNL electrode is expected to be placed at a designated thoracic site without ambiguity, and thus in conjunction with the limb leads I and II, to yield a hybrid 12-lead ECG with the conventional 6 limb leads and 6 derived V1-V6 leads. The SNL will result in the elimination of the problems of variation in the placement of V1-V6 electrodes, and the noncompliance of placing the V1-V6 electrodes at the recommended thoracic sites, and the resultant variation in the amplitude and morphology of the V1-V6 leads in serial ECGs.