A standardized procedure for locating and documenting ECG chest electrode positions - Consideration of the effect of breast tissue on ECG amplitudes in women
A standardized procedure for locating and documenting ECG chest electrode positions - Consideration of the effect of breast tissue on ECG amplitudes in women
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DOI：
10.1016/s0022-0736(98)90003-6
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发表时间：
1998-01-01
影响因子：
1.3
通讯作者：
Crow, R
中科院分区：
文献类型：
--
作者：
Rautaharju, PM;Park, L;Crow, R
心电图（ECG）胸部电极放置的标准化程序仍然存在不确定性，技术变化是胸导联心电图振幅和波形短期变化的最大误差来源。为了避免因乳房组织丰富而导致心电图振幅衰减，女性的前外侧胸部电极通常放置在乳房下方且位置过低。锁骨中线和V-4电极的定位也存在相当大的不确定性，特别是在肥胖人群和女性中。我们利用纳入社区动脉粥样硬化研究（ARIC）的6814名妇女的心电图和人体测量数据，研究了乳房组织隆起对ECG肽的影响。胸前外侧导联R波振幅和Sokolow-Lyon电压均随乳房隆起程度的增加而降低（P < 0.001）， RaVL和Cornell电压显著升高（P < 0.001）。然而，这些影响很小（乳房隆起每增加1厘米，影响小于等于15 μ V）， R-2值小于。01，表明乳房突出单独解释不到1%的心电图振幅变化。当胸围和乳房突出同时被输入多元回归模型时，胸围似乎占主导地位，模型R-2值与RaVL （R-2 = 0.12）和Cornell电压（R-2 = 0.04）呈正相关。组合模型R-2值保持小于或等于。其他心电图振幅为01。制定了详细的一步一步标准化电极放置程序。由于通过目视检查定位左锁骨中线遇到的困难，我们引入了明确的程序来识别和记录侧胸电极放置位置，作为临床试验的质量控制方法。本文介绍了第三次全国健康与营养调查的人群数据，包括按性别和种族划分的胸部电极V-4和V-6位置分布以及胸部大小和形状的人体测量数据，以便于评估各种研究中胸部电极放置程序的可比性和临床试验的质量控制，结论是记录胸部电极放置位置的标准化程序是可行的。乳房组织似乎对心电图振幅的影响几乎可以忽略不计，在女性中，建议将胸部电极放置在乳房上而不是乳房下，以促进电极在正确的水平水平和正确的侧位上放置的精度。
Continuing uncertainty exists about standardized procedures for the placement of electrocardiographic (ECG) chest electrodes, technical variability being the largest error source for short-term variations in amplitudes and waveforms of the chest lead ECGs. To avoid presumed attenuation of ECG amplitudes by abundant breast tissue, anterolateral chest electrodes in women are often placed under the breasts and too low. There is also considerable uncertainty about locating the midclavicular line and the V-4 electrode, particularly in obese persons and in women. We examined the effect of breast tissue protuberance on ECG amplutides using ECG and anthropometric data on 6,814 women included in the Atherosclerosis Research in Communities Study (ARIC). The R wave amplitudes in anterolateral chest leads and the Sokolow-Lyon voltage decreased (P < .001 for all), and RaVL and the Cornell voltage increased significantly with increasing breast protuberance (P < .001 for all). However ever, these effects were small (15 mu V or less for each 1-cm increment in breast protuberance), and R-2 values were less than .01, indicating that breast protuberance alone explained less than 1% of ECG amplitude variations. When chest size and breast protuberance estimates were entered simultaneously into a multivariate regression model, chest size appeared to dominate, and model R-2 values increased for positive associations with RaVL (R-2 = .12) and the Cornell voltage (R-2 = .04). Combined model R-2 values remained less than or equal to.01 for all other ECG amplitudes. A detailed step-by-step standardized electrode placement procedure was formulated. Because of the difficulties encountered in locating the left midclavicular line by visual inspection, we introduced well-defined procedures for identification and documentation of lateral chest electrode placement locations as a quality control method for clinical trials. Population data from the Third National Health and Nutrition survey on the distributions by sex and race ol chest electrode V-4 and V-6 locations and anthropometric data un chest size and shape are presented in order to facilitate evaluation of the comparability ol electrode placement procedures in various studies and for quality control in clinical trials, It is concluded that standardized procedures to document chest electrode placement locations are feasible. Breast tissue appears tu have a practically negligible effect on ECG amplitudes, and in women, the placement of chest electrodes on the breast rather than under the breast is recommended in order ro facilitate the precision of electrode placement at the correct horizontal level and at the correct lateral positions.