THE STANDARD LEAD SYSTEM PLACEMENT

Prepared and Presented by Abdiqathar Rashid Kulmie. RN

28/12/2020 Prepared and presented by Abdiqathar Rashid Kulmie. RN 1

THE STANDARD LEAD SYSTEM

Electrodes and Leads:

To record an electrocardiogram, a number of electrodes, usually five, are

affixed to the body of the patient. The electrodes are connected to the ECG

machine by the same number of electrical wires known as leads.

The electrode applied to the right leg of the patient, for example, is called RL

lead.

To avoid ambiguity between electrodes and the measuring techniques, we use

lead term for the particular group of electrodes taken for the measurements.

28/12/2020 Prepared and presented by Abdiqathar Rashid Kulmie. RN 2

Continuation…
For individual lead wire, as well as the physical connection to the body of the
patient, the term electrode will be used.

When ECG recorded by using certain placement of the electrode, may be

some aspects of the waveform missed.

To avoid this problem, usually 12 different leads techniques are used so that
no important detail of the waveform is missed.

Placement of electrodes and names and configurations of the leads have

become standardized and are used the same way throughout the world.

They include:
 Three Bipolar Limb leads ( Lead I, II and II)

 Three Augmented Unipolar Leads (aVF, aVR and aVL)

 Six Precordial Chest Leads (V1,V2,V3,V4,V5 and V6)

28/12/2020 Prepared and presented by Abdiqathar Rashid Kulmie. RN 3
1. THREE BIPOLAR LIMB LEADS
LEAD CONNECTIONS
LEAD-I Left Arm(LA) and Right Arm (RA)

LEAD-II Left Leg (LL) and Right Arm (RA)

LEAD-III Left leg (LL) and Left Arm (LA)

These three leads are called bipolar because for each lead
the ECG is recorded from two electrodes and third electrode
is not connected.

In each of these lead positions, the QRS of a normal heart is

such that the R wave is positive.

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2. THREE AUGMENTED UNIPOLAR
The other leads are known as unipolar type, which was
introduced by Wilson in 1994.

For unipolar leads, the ECG is recorded between single

exploratory electrode and the central terminal, which has a
potential corresponding to the center of the body. Three active
limb electrodes together through resistors of equal size.

In augmented unipolar limb leads, the electrode used as an

exploratory electrode is not used for the central terminal.
These leads are aVR, aVL and aVF.(see upcoming figure)

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THE STANDARD LEAD SYSTEM

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3. SIX PRECORDIAL LEADS (CHEST LEADS)
The remaining leads are unipolar chest leads.

These chest positions are called the precordial unipolar leads and
are designated V1 through V6.

All three active limb electrodes are used to obtain the central
terminal, while a separate chest electrode is used as an
exploratory electrode.

We will see the connection type of the precordial unipolar leads
also we will see the various ECG wave forms for the particular
patient by using different leads techniques in upcoming diagrams.

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NORMAL 12 LEAD ECG

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