Precordial lead placement

To record a 12-lead ECG, place electrodes on the patient’s

arms and left leg and place a ground lead on the patient’s
right leg. The three standard limb leads (I, II, and III) and the
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three augmented leads (aVR, aVL, and aVF) are recorded using
these electrodes. Then, to record the precordial chest leads,
place electrodes as follows:
● V1 — fourth intercostal 12-lead electrocardiograms
space (ICS), right sternal
border
● V2 — fourth ICS, left SELECTING LEAD SITES
sternal border ● Choose areas that are flat and fleshy, not muscular or
● V3 — midway between bony.
V2 and V4 ● As needed, take steps to enhance electrode contact with
● V4 — fifth ICS, left the skin:
midclavicular line —Clip (don’t shave) excessively hairy areas.
● V5 — fifth ICS, left anterior —Remove excess oil and other substances from the skin.
axillary line ● To ensure an accurate recording, be sure to apply the
● V6 — fifth ICS, left electrodes correctly.
midaxillary line ● Keep in mind that inaccurate placement of an electrode
may lead to inaccurate waveforms and incorrect ECG
V1 V4 interpretation.

PLACING THE LEADS

V2 V5 Limb leads
● Place electrodes on both of the patient’s arms and on his
left leg.
● Place an electrode on his right leg. (This is a ground
V3 V6 that doesn’t contribute to the waveform.)
Precordial leads
● Place the six unipolar precordial leads (V1 through V6)
_____________________________________________________________________ in sequence across his chest.
Source: ECG Interpretation: An Incredibly Easy! Pocket Guide, Lippincott
Williams & Wilkins, 2006.
Take5: © Lippincott Williams & Wilkins, 2006
Limb lead placement
Proper lead placement is crucial for accurate recording of
cardiac rhythms. These drawings show correct electrode
placement for the six limb leads. RA stands for right arm;
LA, left arm; RL, right leg; and LL, left leg. A plus sign (+)
indicates a positive pole; a minus sign (-), a negative pole; and
G indicates a ground. Below each drawing is a sample ECG
strip for that lead.

Lead I Lead II Lead III Lead aVR Lead aVL Lead aVF
Connects the right Connects the right Connects the left Connects the right Connects the left Connects the left leg
arm (negative pole) arm (negative pole) arm (negative pole) arm (positive pole) arm (positive pole) (positive pole) with
with the left arm with the left leg with the left leg with the heart with the heart the heart (negative
(positive pole). (positive pole). (positive pole). (negative pole). (negative pole). pole).