Electrode position effects on Frank lead electrocardiograms

Abstract

Frank lead electrocardiograms were recorded from 149 normal and abnormal adult males using four different electrode placements. All chest electrodes were placed at: (1) the fourth intercostal space level, (2) the fifth intercostal space level, (3) the fourth intercostal space level with V 4 substituted for C, and (4) the fifth intercostal space level with V 4 substituted for C. Differences in mean values of many commonly used amplitudes and orientations were not statistically significant among the four recording methods, but amplitude differences for individual subjects were often large and difficult to predict. When V 4 is substituted for C, as commonly done in some laboratories, R x decreased and R z increased by more than 10 per cent in about 40 per cent of the cases. In about 70 per cent of the cases, R x and R z changed significantly when electrode level was shifted from the fifth to the fourth intercostal space. For these 70 per cent, it does not appear possible to accurately predict increase or decrease of R x, R z, or QRS m. Analysis programs which depend on individual amplitude measurements are likely to be significantly affected by electrode placement. It is suggested that criteria for analysis programs developed using a specified version of the Frank system should ideally be applied only to electrocardiograms recorded in the same manner.