Machine learning techniques for detecting electrode misplacement and interchanges when recording ECGs: A systematic review and meta-analysis  

Khaled Rjoob, RR Bond, D Finlay, V. E. McGilligan, Stephen James Leslie, Ali Rababah, D Guldenring, Aleeha Iftikhar, Charles Knoery, Anne McShane, Aaron Peace

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)
132 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)116-123
Number of pages8
JournalJournal of Electrocardiology
Early online date19 Aug 2020
Publication statusPublished (in print/issue) - 1 Sep 2020

Bibliographical note

Funding Information:
This work is supported by the European Union 's INTERREG VA programme, managed by the Special EU Programmes Body (SEUPB). The work is associated with the project – ‘Centre for Personalised Medicine – Clinical Decision Making and Patient Safety’. The views and opinions expressed in this study do not necessarily reflect those of the European Commission or the Special EU Programmes Body (SEUPB) . Grant number is IVA5036 .

Publisher Copyright:
© 2020 Elsevier Inc.

Copyright 2020 Elsevier B.V., All rights reserved.


  • Chest leads
  • Electrode misplacement
  • Lead misplacement
  • Limb leads
  • Machine learning


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