PMID- 32656045
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 7
DP  - 2020 Jul 7
TI  - Precordial ECG Lead Mispositioning: Its Incidence and Estimated Cost to 
      Healthcare.
PG  - e9040
LID - 10.7759/cureus.9040 [doi]
LID - e9040
AB  - BACKGROUND: The study was performed to estimate the incidence and economic burden 
      of electrocardiogram (ECG) precordial lead mispositioning, in an effort to 
      highlight the need for quality improvement. Lead mispositioning may result in 
      further cardiovascular testing to rule out significant cardiac disease, thus 
      adding to the national healthcare financial burden. METHODS: All consecutive 
      adult ECGs done during 2018, were reviewed. ECGs with acute anterior myocardial 
      infarction (AMI), bundle branch blocks, left ventricular hypertrophy (LVH), left 
      anterior fascicular block (LAFB), pre-excitation, left axis deviation, 
      ventricular pacing and low voltage QRS were excluded. Septal infarcts identified 
      automatically by the computerized software or identified manually using the 
      criteria of QS composite in V2 were not excluded. Computer interpreted ECGs as 
      "cannot rule-out anterior infarct" were also not excluded from this 
      data. Reimbursement of various stress test types was used to estimate the cost 
      burden of misdiagnosed ECGs. RESULTS: A total of 9424 adult ECGs were 
      evaluated. Poor R-wave progression (PRWP) or reversed R-wave progression (RRWP) 
      accounted for 497 (5.27%) and 102 (1.08%) ECGs, respectively. A total of 335 
      septal infarct interpretations constituted about 3.55% of all ECGs. ECGs 
      categorized as "cannot rule-out AMI" due to PRWP constituted about 0.89%. 
      Therefore, a total of 1018 ECGs (10.8%) could be possibly falsely labelled as 
      some type of myocardial infarction. CONCLUSION: Precordial ECG lead 
      mispositioning can lead to significantly abnormal ECG patterns, leading to false 
      diagnoses and further unnecessary cardiovascular testing. This not only increases 
      risk and cost to the patient, but also adds to the national healthcare financial 
      burden.
CI  - Copyright (c) 2020, Rehman et al.
FAU - Rehman, Mahin
AU  - Rehman M
AD  - Internal Medicine, Guthrie Clinic, Robert Packer Hospital, Sayre, USA.
FAU - Rehman, Najeeb U
AU  - Rehman NU
AD  - Cardiology, Guthrie Clinic, Robert Packer Hospital, Sayre, USA.
LA  - eng
PT  - Journal Article
DEP - 20200707
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7343296
OTO - NOTNLM
OT  - cardiology
OT  - cardiology devices
OT  - cardiovascular disease
OT  - cardiovascular education
OT  - ecg
OT  - economic burden of healthcare
OT  - ekg
OT  - electrocardiography
OT  - healthcare cost
OT  - lead misplacement
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/07/14 06:00
MHDA- 2020/07/14 06:01
PMCR- 2020/07/07
CRDT- 2020/07/14 06:00
PHST- 2020/07/14 06:00 [entrez]
PHST- 2020/07/14 06:00 [pubmed]
PHST- 2020/07/14 06:01 [medline]
PHST- 2020/07/07 00:00 [pmc-release]
AID - 10.7759/cureus.9040 [doi]
PST - epublish
SO  - Cureus. 2020 Jul 7;12(7):e9040. doi: 10.7759/cureus.9040.