ECG Lead Placement and
Identifying Lead Reversal
This quick reference guide is intended to show correct ECG electrode locations and
how to recognize inadvertent lead wire reversal.
Limb lead placement
For accurate 12-lead measurements and interpretation, limb leads must be placed on
the limbs, not the torso
For monitoring rhythm and rate, limb leads may be placed on the limbs or torso
Lead reversal
Ensuring that the ECG leads are connected to the correct ECG electrode position is
very important for acquiring accurate rhythm strips and 12-lead ECGs
Lead reversal usually produces recognizable ECG abnormalities
12-lead ECG: chest electrode locations
Electrode Location
V1 C1 4th intercostal space at right border of the sternum
V2 C2 4th intercostal space at left border of the sternum
V3 C3 Midway between V2 and V4
V4 C4 5th intercostal space at midclavicular line
V5 C5 Level with V4 at left anterior axillary line
V6 C6 Level with V4-V5 at left midaxillary line
12-lead ECG: additional chest electrode locations
Note: automated interpretation may be invalid if V leads are moved to these locations
Electrode Location
V3R C3R Midway between V1 and V4R
V4R C4R 5th intercostal space, right midclavicular line
V5R C5R Level with V4R at right anterior axillary line
V7 C7 Level with V4-V6 at left posterior axillary line
V8 C8 Level with V4-V6 at left midscapular line
V9 C9 Level with V4-V6 at left spinal border
12-lead: limb electrode locations
Choose an ECG electrode site away
from areas with a large amount of
adipose tissue, major muscle groups or
bony prominences
Limb electrodes can be placed any-
where on the arms distal to the axillary
fold, and anywhere on the legs
Electrode Standard Location
RA R Right arm, near the wrist
LA L Left arm, near the wrist
RL N Right leg, above the
right ankle
LL F Left leg, above the
left ankle
Frontal Image
1 2 345 6
Lateral I mage
123 4 5 6
Right-Side Leads
5R 4R 313R 2 4 5 6
Posterior Leads
67 8 9
RA
R
LA
L
RL
N
LL
F
AHA leadwire labels in first column, IEC labels in second column
GDR 3323919_A
