Abstract
Background: The study was performed to estimate the incidence and economic burden of electrocardiogram (ECG) precordial lead mispositioning, in an effort to highlight the need for quality improvement. Lead mispositioning may result in further cardiovascular testing to rule out significant cardiac disease, thus adding to the national healthcare financial burden.Methods: All consecutive adult ECGs done during 2018, were reviewed. ECGs with acute anterior myocardial infarction (AMI), bundle branch blocks, left ventricular hypertrophy (LVH), left anterior fascicular block (LAFB), pre-excitation, left axis deviation, ventricular pacing and low voltage QRS were excluded. Septal infarcts identified automatically by the computerized software or identified manually using the criteria of QS composite in V2 were not excluded. Computer interpreted ECGs as “cannot rule-out anterior infarct” were also not excluded from this data. Reimbursement of various stress test types was used to estimate the cost burden of misdiagnosed ECGs.Results: A total of 9424 adult ECGs were evaluated. Poor R-wave progression (PRWP) or reversed R-wave progression (RRWP) accounted for 497 (5.27%) and 102 (1.08%) ECGs, respectively. A total of 335 septal infarct interpretations constituted about 3.55% of all ECGs. ECGs categorized as “cannot rule-out AMI” due to PRWP constituted about 0.89%. Therefore, a total of 1018 ECGs (10.8%) could be possibly falsely labelled as some type of myocardial infarction.Conclusion: Precordial ECG lead mispositioning can lead to significantly abnormal ECG patterns, leading to false diagnoses and further unnecessary cardiovascular testing. This not only increases risk and cost to the patient, but also adds to the national healthcare financial burden.
Highlights
The heartbeat is a mechanical function of the heart triggered by an electrical impulse
During 2018, there were a total of 9,424 ECG records available from 6,417 adult patients who had their ECG done as outpatient in one of the designated cardiology clinics
These ECGs were reviewed on the GE MuseTM 8.0.1 Cardiology Information System (Milwaukee, WI, USA)
Summary
The heartbeat is a mechanical function of the heart triggered by an electrical impulse This electrical impulse consists of depolarization and repolarization signals resulting in cardiac systole and diastole. The process of recording an ECG involves preparing the patient and their skin, accurate electrode placement, and checking the electrocardiograph settings and other equipment required for the procedure. Precordial electrodes are placed either too high or too low vertically and/or are horizontally displaced as well from their normal anatomically defined locations [5]. These lead mispositioning errors result in erroneous interpretation of ECGs [6]. Lead mispositioning may result in further cardiovascular testing to rule out significant cardiac disease, adding to the national healthcare financial burden
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