Diagnostic ECG Lead Placement

Stress Holter
Modified Mason-Likar Electrode Placement Two Channel, 5 Electrode Lead Placement
AHA Label IEC Label Electrode Location In this configuration, two channels of ECG data are bipolar.
Red positive (+) is referenced to white negative (–) and
V1 (red) C1 (red) Fourth intercostal space at the B D
RA LA brown positive (+) is referenced to black negative (–)
right sternal border.
V2 (yellow) C2 (yellow) Fourth intercostal space at the Poster AHA IEC
left sternal border. Label Color Color Channel Lead Location
V3 (green) C3 (green) Midway between locations V2 V1 V2 A Red Yellow CH 1(+) II (+) Fifth intercostal space,
V3 C A anterior axillary line.
and V4 (C2 & C4).
V4 V5 V6 B White Red CH 1 (–) II (–) Below the right clavicle, just lateral
V4 (blue) C4 (brown) Mid-clavicular line in the fifth
intercostal space. to the mid-clavicular line.
V5 (orange) C5 (black) Anterior axillary line on the same C Brown Green CH 2 (+) mV1 (+) Fourth intercostal space,
horizontal level as V4 (C4). right sternal edge.
E D Black White CH 2 (–) mV1 (–) Below the left clavicle, just lateral
V6 (purple) C6 (purple) Mid-axillary line on the same RL LL
horizontal level as V4 and V5 to the mid-clavicular line.
(C4 & C5). Two Channel, 5 Electrode E Green Black Ground On the lower right chest wall,
LA (black) L (yellow) Just below the clavicle of the on a rib.
left arm.
RA (white) R (red) Just below the clavicle of the Three Channel, 7 Electrode Lead Placement
right arm. This modified V3 lead configuration may be helpful in identifying ST segment
LL (red) F (green) Lower left abdominal quadrant. B F D changes in ischemic episodes associated with the left anterior descending
coronary artery. The following are the recommended electrode locations to
RL (green) N (block) Lower right abdominal quadrant.
record modified V5 (mV5) on channel 1, the modified V1 (mV1) on channel 2,
and the modified V3 (mV3) on channel 3.
A3 C Poster AHA IEC
E A Label Color Color Channel Lead Location
A Red Yellow CH 1 (+) mV5 (+) Fifth intercostal space at the left
CL Lead Placement axillary line.
When operating to obtain CM5, CC5 and CH, the A1, A2, and A3 B White Red CH 1 (–) mV5 (–) Right clavicle, just lateral to the
leadwires must be connected as follows: A1 sternum.
Label Electrode Location G C Brown Green CH 2 (+) mV1 (+) Fourth intercostal space at the
A1 Mid-sternum at the second right sternal edge.
intercostal space. D Black White CH 2 (–) mV1 (–) Left clavicle, just lateral to the
A2 In the fifth intercostal space in the A2 sternum.
right anterior axillary line E Orange Orange CH 3 (+) mV3 (+) Equidistant between the normal
(V5R / C5R). locations for precordial leads
A3 On either side of the neck or V2 and V4.
anywhere above the shoulders. F F Blue Blue CH 3 (–) mV3 (–) Mid-sternum, at the level of the
B D clavicles.
G Green Black Ground On the lower right chest wall,
on a rib.

ML Lead Placement C
A
When operating to obtain CM5, CC5 and ML, the A1 and A2 Modified aVF Leads
E A modified aVF Lead may be helpful in identifying ST Segment changes in
leadwires must be connected as follows:
A1 ischemic episodes associated with the right coronary or circumflex arteries.
Label Electrode Location The following are the recommended electrode locations to record the modified
A1 Mid-sternum at the second V5 (mV5) on channel 1, the modified V1 (mV1) on channel 2, and the modified
G
intercostal space. aVF (maVF) on channel 3.
A2 In the fifth intercostal space in the A2 Poster AHA IEC
right anterior axillary line (V5R / C5R). Label Color Color Channel Lead Location
A Red Yellow CH 1 (+) mV5 (+) Fifth intercostal space at the
left axillary line.
B White Red CH 1 (–) mV5 (–) Right clavicle, just lateral to
the sternum.
B D C Brown Green CH 2 (+) mV1 (+) Fourth intercostal space at
the right sternal edge.

Resting C F
D Black White CH 2 (–) mV1 (–) Left clavicle, just lateral to
the sternum.
A E Orange Orange CH 3 (+) maVF (+) Sixth rib, at the left
mid-clavicular line.
Traditional 12 Electrode Placement F Blue Blue CH 3 (–) maVF (–) Left clavicle, at the
AHA Label IEC Label Electrode Location mid-clavicular line.
V1 (red) C1 (red) Fourth intercostal space at the G Green Black Ground On the lower right chest wall,
right sternal border. G on a rib.
V2 (yellow) C2 (yellow) Fourth intercostal space at the
left sternal border. Modified Z Leads
V3 (green) C3 (green) Midway between locations V2 A modified Z-Lead (mZ) may be helpful in identifying ST Segment changes
and V4 (C2 & C4). in ischemic episodes with an anteroposterior axis. The following are the
V4 (blue) C4 (brown) Mid-clavicular line in the fifth V1 V2 recommended electrode locations to record the modified V5 (mV5) leads
intercostal space. RA V3 LA on channel 1, modified V1 (mV1) leads on channel 2, and Z leads on channel 3.
V5 (orange) C5 (black) Anterior axillary line on the same V4 V5 V6
horizontal level as V4 (C4). Poster AHA IEC
Label Color Color Channel Lead Location
V6 (purple) C6 (purple) Mid-axillary line on the same
horizontal level as V4 and V5 A Red Yellow CH 1 (+) mV5 (+) Fifth intercostal space at the left
(C4 & C5). E axillary line.
LA (black) L (yellow) Left deltoid. B White Red CH 1 (–) mV5 (–) Right clavicle, just lateral to the
RL LL
sternum.
RA (white) R (red) Right deltoid.
C Brown Green CH 2 (+) mV1 (+) Fourth intercostal space at the
LL (red) F (green) Above the ankle. right sternal edge.
(Alternate placement: Upper leg as
close to torso as possible) D Black White CH 2 (–) mV1 (–) Left clavicle, just lateral to the
sternum.
RL (green) N (block) Above the ankle.
(Alternate placement: Upper leg as E Orange Orange CH 3 (+) mV3 (+) Posterior, just right of the spine, at
close to torso as possible) the same level as the anterior lead.
F Blue Blue CH 3 (–) Z (–) Mid-sternum, at the level of the
Traditional 15 Electrode Placement fourth intercostal space.
G Green Black Ground On the lower right chest wall,
on a rib.

Hi-Res / Vector
V1 V2
V7 V8 V9 V9R V8R V7R RA V3R V3 LA H
V6R V5R V4R V4 V5 V6

RL LL RA LA
I E V4 V6 M

Skin Preparation:
Determine electrode placement according to one of the configurations shown on this poster.
Use the following procedure to ensure good quality ECG data: RL LL
1. To minimize electrode problems, be sure to use the proper type of electrode. Check the expiration date on any
pregelled electrode before using it. Also, check for dry cell pads on any pregelled electrodes that have been left out
of their foil package. Frank X, Y and Z Placements
2. Shave hair from the electrode site. This improves conductivity, helps hold the electrode to the skin, and makes
Anterior View
removal of the electrode easier.
AHA Label IEC Label Electrode Location
3. Rub each electrode site thoroughly with alcohol. This removes oil from the skin.
E (orange) E (light blue) At the front midline.
4. Mark each electrode with a felt-tip pen. This provides an easy way to determine when the epidermis has been
V4 (blue) C4 (brown) Mid-clavicular line in the fifth intercostal space.
sufficiently abraded.
V6 (purple) C6 (purple) Mid-axillary line on the same horizontal level as V4 (C4)
5. Use an abrasive pad to remove the epidermal skin layer at each electrode site. The epidermal skin layer has I (orange) I (light blue) Right mid-axillary line on the same horizontal level as V4 and V6.
been removed when the mark left from the felt-tip pen has been erased. LA (black) L (yellow) Left deltoid.
6. Place an electrode on each prepared site. RA (white) R (red) Right deltoid.
LL (red) F (green) Above left ankle. (Alternate placement: Upper leg as close to torso as possible).
Caution: RL (green) N (black) Above right ankle. (Alternate placement: Upper leg as close to torso as possible).
• Make sure that the electrode’s conducting elements do not contact with each other or other metal parts.
• Make sure that the device is not subject to disturbances from the electrical mains. Posterior View
• Use only the specified electrodes for safety. Any other electrode may not give the proper recording and H (orange) H (light blue) Back of neck.
may cause problems with the patient. M (orange) M (light blue) Center of spine on the same horizontal level as V4 and V6 (C4 & C6).

gehealthcare.com © 2019 General Electric Company – All rights reserved.

DOC0259509 Rev2