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Background:
A 12-lead electrocardiogram (ECG) is the most commonly used method to diagnose patients with cardiovascular diseases. However, there are a number of possible misinterpretations of the ECG that can be caused by several different factors, such as the misplacement of chest electrodes.
Objective:
The aim of this study is to build advanced algorithms to detect precordial (chest) electrode misplacement.
Methods:
In this study, we used traditional machine learning (ML) and deep learning (DL) to autodetect the misplacement of electrodes V1 and V2 using features from the resultant ECG. The algorithms were trained using data extracted from high-resolution body surface potential maps of patients who were diagnosed with myocardial infarction, diagnosed with left ventricular hypertrophy, or a normal ECG.
Results:
DL achieved the highest accuracy in this study for detecting V1 and V2 electrode misplacement, with an accuracy of 93.0% (95% CI 91.46-94.53) for misplacement in the second intercostal space. The performance of DL in the second intercostal space was benchmarked with physicians (n=11 and age 47.3 years, SD 15.5) who were experienced in reading ECGs (mean number of ECGs read in the past year 436.54, SD 397.9). Physicians were poor at recognizing chest electrode misplacement on the ECG and achieved a mean accuracy of 60% (95% CI 56.09-63.90), which was significantly poorer than that of DL (P<.001).
Conclusions:
DL provides the best performance for detecting chest electrode misplacement when compared with the ability of experienced physicians. DL and ML could be used to help flag ECGs that have been incorrectly recorded and flag that the data may be flawed, which could reduce the number of erroneous diagnoses.
Electrode misplacement during 12-lead Electrocardiogram (ECG) acquisition can cause false ECG diagnosis and subsequent incorrect clinical treatment. A common misplacement error is the superior placement of V1 and V2 electrodes. The aim of the current research was to detect lead V1 and V2 misplacement using machine learning to enhance ECG data quality to improve clinical decision making. In this particular study, we reasonably assume that V1 and V2 are concurrently superiorly misplaced together. ECGs for 450 patients were extracted from body surface potential maps. Sixteen features were extracted including: morphological, statistical and time-frequency features. Two feature selection approaches (filter method and wrapper method) were applied to find an optimal set of features that provide a high accuracy. To ensure accuracy, six classifiers were applied including: fine tree, coarse tree, bagged tree, Linear Support Vector Machine (LSVM), Quadratic Support Vector Machine (QSVM) and logistic regression. The accuracy of V1 and V2 misplacement detection was 94.3% in the first ICS, 92.7% in the second ICS and 70% in third ICS respectively. Bagged tree was the best classifier in the first, second and third ICS to detect V1 and V2 misplacement.
Background: Electrocardiogram (ECG) lead misplacement can adversely affect ECG diagnosis and subsequent clinical decisions. V1 and V2 are commonly placed superior of their correct position. The aim of the current study was to use machine learning approaches to detect V1 and V2 lead misplacement to enhance ECG data quality. Method: ECGs for 453 patients, (normal n = 151, Left Ventricular Hypertrophy (LVH) n = 151, Myocardial Infarction n = 151) were extracted from body surface potential maps. These were used to extract both the correct and incorrectly placed V1 and V2 leads. The prevalence for correct and incorrect leads were 50%. Sixteen features were extracted in three different domains: time-based, statistical and time-frequency features using a wavelet
transform. A hybrid feature selection approach was applied to select an optimal set of features. To ensure optimal model selection, five classifiers were used and compared. The aforementioned feature selection approach and classifiers were applied for V1 and V2 misplacement in three different positions: first, second and third intercostal spaces (ICS). Results: The accuracy for V1 misplacement detection was 93.9%, 89.3%, 72.8% in the first, second and third ICS respectively. In V2, the accuracy was 93.6%, 86.6% and 68.1% in the first, second and third ICS respectively. There is a noticeable decline in accuracy when detecting misplacement in the third ICS which is expected.
Introduction: Electrode misplacement and interchange errors are known problems when recording the 12‑lead electrocardiogram (ECG). Automatic detection of these errors could play an important role for improving clinical decision making and outcomes in cardiac care. The objectives of this systematic review and meta-analysis is to
1) study the impact of electrode misplacement on ECG signals and ECG interpretation,
2) to determine the most challenging electrode misplacements to detect using machine learning (ML),
3) to analyse the ML performance of algorithms that detect electrode misplacement or interchange according to sensitivity and specificity and
4) to identify the most commonly used ML technique for detecting electrode misplacement/interchange. This review analysed the current literature regarding electrode misplacement/interchange recognition accuracy using machine learning techniques.
Method: A search of three online databases including IEEE, PubMed and ScienceDirect identified 228 articles, while 3 articles were included from additional sources from co-authors. According to the eligibility criteria, 14 articles were selected. The selected articles were considered for qualitative analysis and meta-analysis.
Results: The articles showed the effect of lead interchange on ECG morphology and as a consequence on patient diagnoses. Statistical analysis of the included articles found that machine learning performance is high in detecting electrode misplacement/interchange except left arm/left leg interchange.
Conclusion: This review emphasises the importance of detecting electrode misplacement detection in ECG diagnosis and the effects on decision making. Machine learning shows promise in detecting lead misplacement/interchange and highlights an opportunity for developing and operationalising deep learning algorithms such as
convolutional neural network (CNN) to detect electrode misplacement/interchange.