TY - JOUR
T1 - Anatomical considerations and clinical interpretation of the 12-lead ECG in the prone position
T2 - a prospective multicentre study
AU - Romero, Jorge
AU - Garcia, Mario
AU - Diaz, Juan Carlos
AU - Gabr, Mohamed
AU - Rodriguez-Taveras, Joan
AU - Braunstein, Eric D.
AU - Purkayastha, Sutopa
AU - Gamero, Maria T.
AU - Alviz, Isabella
AU - Marín, Jorge
AU - Aristizábal, Julián
AU - Reynbakh, Olga
AU - Peralta, Adelqui O.
AU - Duque, Mauricio
AU - Dave, Kartikeya P.
AU - Rodriguez, Daniel
AU - Nino, Cesar
AU - Briceno, David
AU - Velasco, Alejandro
AU - Ferrick, Kevin
AU - Slipczuk, Leandro
AU - Natale, Andrea
AU - Di Biase, Luigi
N1 - Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: [email protected].
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Aims: The aim of this study is to provide guidance for the clinical interpretation of electrocardiograms (ECGs) in prone position and to establish the electroanatomic explanations for the possible differences to supine position ECGs that may be observed. Additionally, to determine if prone back ECG can be used as an alternative to standard ECG in patients who may benefit from prone position. Methods and results: The ECG in supine (standard ECG), prone back (precordial leads placed on the patient's back), and prone anterior position (precordial leads placed in the standard position with the subjects in prone position) were prospectively examined on 85 subjects. Comparisons of ECG parameters between these positions were performed. Computed tomography (CT) scans were performed in both positions to determine possible electroanatomic aetiologies for prone-associated ECG changes. There were significant differences in QRS amplitude in Leads V1-V5 between supine and prone positions. Q waves were more frequently observed in prone back position vs. supine position (V1: 74.1 vs. 10.6%, P < 0.0001; V2: 23.5 vs. 0%, P < 0.0001, respectively). Flat and inverted T waves were more common in prone back leads (V1: 98 vs. 66%, P < 0.0001; V2: 96 vs. 8%, P < 0.0001; V3: 45 vs. 7%, P < 0.0001). The 3D-CT reconstructions measurements corroborated the significant inverse correlation between QRS amplitude and the distance from the centre of the heart to the estimated lead positions. Conclusion: In prone back position ECG, low QRS amplitude should not be misinterpreted as low voltage conditions, neither should Q waves and abnormal T waves are considered anteroseptal myocardial infarction. These changes can be explained by an increased impedance (due to interposing lung tissue) and by the increased distance between the electrodes to the centre of the heart.
AB - Aims: The aim of this study is to provide guidance for the clinical interpretation of electrocardiograms (ECGs) in prone position and to establish the electroanatomic explanations for the possible differences to supine position ECGs that may be observed. Additionally, to determine if prone back ECG can be used as an alternative to standard ECG in patients who may benefit from prone position. Methods and results: The ECG in supine (standard ECG), prone back (precordial leads placed on the patient's back), and prone anterior position (precordial leads placed in the standard position with the subjects in prone position) were prospectively examined on 85 subjects. Comparisons of ECG parameters between these positions were performed. Computed tomography (CT) scans were performed in both positions to determine possible electroanatomic aetiologies for prone-associated ECG changes. There were significant differences in QRS amplitude in Leads V1-V5 between supine and prone positions. Q waves were more frequently observed in prone back position vs. supine position (V1: 74.1 vs. 10.6%, P < 0.0001; V2: 23.5 vs. 0%, P < 0.0001, respectively). Flat and inverted T waves were more common in prone back leads (V1: 98 vs. 66%, P < 0.0001; V2: 96 vs. 8%, P < 0.0001; V3: 45 vs. 7%, P < 0.0001). The 3D-CT reconstructions measurements corroborated the significant inverse correlation between QRS amplitude and the distance from the centre of the heart to the estimated lead positions. Conclusion: In prone back position ECG, low QRS amplitude should not be misinterpreted as low voltage conditions, neither should Q waves and abnormal T waves are considered anteroseptal myocardial infarction. These changes can be explained by an increased impedance (due to interposing lung tissue) and by the increased distance between the electrodes to the centre of the heart.
KW - 12-Lead ECG
KW - Acute respiratory distress syndrome
KW - Electrocardiogram
KW - Electrocardiography
KW - Prone position
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U2 - 10.1093/europace/euac099
DO - 10.1093/europace/euac099
M3 - Article
C2 - 36196043
AN - SCOPUS:85147783455
SN - 1099-5129
VL - 25
SP - 175
EP - 184
JO - Europace
JF - Europace
IS - 1
ER -