EKG Lead Placement

[scrubsfan21]

I have a question, more a debate. As an exercise physiologist, I was told by a fellow collague that if you have a patient with a pacemaker that you can place the lead on the patient's scapulae and get the same results. The same with the lower limb leads and his or her pants to high and you can't get where you need, you can place those leads on the sides of the spine. He said, technically it is not correct, but it will not adversely effect the outcome.

My question is how accurate is this? And if this is okay where is the literature to support it? and finally, will it effect the ECG outcomes? I appreciate all help on this! (Sorry, if it sounds crazy, but writing fast)!

[chare]

it depends. if you are obtaining a diagnostic 12 lead ekg then lead placement is absolutely essential. not only to ensure an accurate report, but to ensure consistency between subsequent studies. if you are obtaining a 12 lead ekg than the limb leads are typically placed at the wrists/ankles.

if you are monitoring the ecg during an exercise procedure, then placement of the leads will not have much effect as all you are monitoring for is ectopy and/or rate.