In this ECG Cases blog we look at pitfalls from ECG artifact and lead misplacement, and pearls to prevent misdiagnosis.

Written by Jesse McLaren; Peer Reviewed and edited by Anton Helman, August, 2024.

Five patients had ECGs suggesting dangerous pathologies. Which were simply ECG acquisition errors?

Case 1: 95-year-old, history of AF, with shortness of breath. Is this polymorphic VT?

Case 2: 60-year-old with syncope. Is this atrial fibrillation?

Case 3: 60-year-old, recent alcohol and crack use, with vomiting. Is this inferior infarct?

Case 4: 60-year-old with intermittent chest pain. Is this septal infarct?

Case 5: 20-year-old with syncope. Is this Brugada or STEMI?

ECG artifact and lead misplacement

Before interpreting an ECG, you need to make sure it has been properly acquired. There are four common types of ECG acquisition error:

  • Artifact:
    • Pitfall: can mimic tachy-arrhythmias
    • Pearl: unaffected lead recorded at the same time, or if there are narrow R waves marching through the noise
  • limb lead reversal:
    • Pitfall: can mimic infarct or ischemia
    • Pearl: consider if there’s abnormal atrial axis (P wave in normal sinus should be upright in I and II, taller in II than in I, and inverted in aVR), abnormal ventricular axis, or if one of the limb leads has a flat line
  • high precordial lead
    • Pitfall: can mimic septal infarct, Wellens, or Brugada
    • Pearl: P wave from sinus rhythm should be biphasic in V1 and upright in V2. Consider high lead placement if P wave is fully inverted V1 or not fully upright in V2, and if aVR/V1/V2 all look similar
  • precordial lead reversal
    • Pitfall: can mimic infarct
    • Pearl: consider if bizarre R wave progression

Back to the cases

Case 1: 95-year-old, history of AF, with shortness of breath. Is this polymorphic VT?

Apparent polymorphic wide complex tachycardia, but lead I is unaffected, and there are narrow R waves marching through the noise. ECG repeated: atrial fibrillation with narrow QRS:

Case 2: 60-year-old with syncope. Is this atrial fibrillation?

There appears to be atrial fibrillation but the rhythm is regular, and lead I shows clear P waves without artifact. ECG repeated: normal sinus rhythm.

Case 3: 60-year-old, recent alcohol and crack use, with vomiting. Is this inferior infarct?

There’s an apparent left axis deviation from inferior Q waves with T wave inversion, but they are all preceded by inverted P waves. Sinus rhythm should have P wave upright in II and inverted in aVR but this is the opposite. There’s also a T wave inversion in V2 preceded by an inverted P wave. So there’s both limb lead misplacement and high precordial lead placement. ECG repeated with correct placement: normal sinus rhythm (P wave upright in II>I and inverted in aVR, biphasic in V1 and upright in V2) and normal ECG

Case 4: 60-year-old with intermittent chest pain. Is this septal infarct?

Apparent Q and T wave inversion in V2. But P wave is fully inverted in V1 and biphasic in V2, and aVR/V1/V2 all look similar. This is high lead placement of V1-2. ECG repeated with lead correction: now P wave is biphasic in 1 and upright in 2, and ECG is normal

Case 5: 20-year-old with syncope. Is this Brugada or STEMI?

Apparent saddle-back ST elevation in V2 and ST elevation with large T wave in V1. But the P waves are not fully upright in V2-3, and the R wave progression is bizarre (tall R in V1, then small V2-3 then tall again V3), from precordial lead reversal and high lead placement. ECG repeated: now normal P waves and normal R wave progression, with baseline tall voltages and proportional ST/T

Take home points on ECG artifact and lead misplacement

  1. Artifact: consider if apparent tachy-arrhythmia spares a lead, or if there’s narrow R waves marching through the noise
  2. Limb lead reversal: consider if abnormal atrial axis, abnormal ventricular axis, or flat line in one of the limb leads
  3. High precordial lead: consider if P wave is fully inverted in V1 or not fully upright in V2, and if aVR/V1/V2 all look similar
  4. Precordial lead reversal: consider if R wave progression is bizarre

For more cases and articles from the literature, see ECG Cases 29: misdiagnosis from lead misplacement, artifact and lead reversal

* For interactive, online, and live ECG interpretation courses for medical/paramedic/nursing students, residents, paramedics, cardiac technologists, and emergency physicians, visit heartsECGcourse.com.