Three(3),Five(5),Ten(10) Lead ECG Lead /Cable/Electrode Placement

Hi, This is another article to guide the users for ECG lead electrodes/cables placement  from team Biometric Cables, a company engaged in manufacturing of ECG Cables for the past 15 years.

In this guide, we will explain the ECG lead/ Cable/Electrode placement in a simplified manner.

ECG Definition:

Electrocardiograph is an Instrument used to record electrical activity of the heart, non-invasively, which reflects contraction and relaxation of Cardiac muscles in a Cardiac cycle.

Basics of ECG:

An Electrocardiogram or ECG is also known as EKG in German speaking countries

There are of two types of Electrocardiogram used for diagnosis:

Monitoring Electrocardiogram- Real time display of the ECG waveform on a Multi-parameter Monitor. Generally, the ECG waveform is of 3/5/6 leads.

Recording Electrocardiogram- Capture of ECG waveform for a given time and the ECG waveforms printed as Graphical representation in an ECG Machine. Generally, the waveform is of 12 ECG Leads.

ECG waveform Interpretation




                                                                                          Fig (a) ECG Waveform Representation


A normal Cardiac cycle comprises of:

Atrial depolarization represented by P Wave.

Depolarization of Atrial i.e. Intra-Ventricular Spectrum represented by Q Wave.

Depolarization of main mass of ventricles represented by R Wave (i.e. upward   Deflection after Q wave).

Repolarization of Ventricles represented by S Wave (i.e. Downward deflection after R wave)

Repolarization of Ventricles represented by T Wave. 


Placement and Position of Chest Leads (ECG Leads Position and Placement):

Before placing the ecg electrodes on Human body, we need to understand the logic based on which the electrodes/ ecg leads are placed.

The Heart is located behind and slightly to the left of sternum. The electrical activity arises out of heart muscles and passes through the soft tissues which can be harnessed superficially over the skin. Hence it is important to know the anatomy before placing the electrodes in right place.



                              Fig. B:  Placement of chest leads


 Skin Preparation:

Skin is a poor conductor of electricity and therefore skin resistance plays a critical role in acquisition of ECG trace quality.

To reduce resistance at the skin and ecg electrode contact following steps are to be taken

1)  If needed excessive hair on the skin must be removed with water, soap and non-alcohol wipes.

2) The skin must be dry and free from dead cells and oil.

3) Dry the Skin vigorously to increase the Capillary blood flow of the tissue.

4) Electrodes must be full contact with the skin.

5) Choose proper position of electrodes based on manufacturer’s recommendation.

 ECG Leads:

A pair of electrodes or a combination of several electrodes through resistance  network that gives an equivalent pair is referred as a Lead.

There are 3 type of leads in typical ECG wave forms:

Unipolar /Augmented leads( aVR, aVL,aVF) 

Bipolar leads ( Lead I, Lead II, Lead III)

Precordial / Chest Leads ( C1,C2,C3,C4,C5,6)

 Unipolar leads/Augmented: 

A lead consisting of Single positive electrode and a reference point is a unipolar lead also called augmented lead

aVR: Right arm absolute potential

aVL: Left arm absolute potential

aVF: Left leg absolute potential

Bipolar Leads:

    A lead consisting of two electrodes of opposite polarity is called bipolar lead, Bipolar lead wave forms derived from Limb Electrodes.

Lead I - Potential difference between right arm and left arm

Lead II - Potential difference between right arm and left leg

Lead III - Potential difference between left arm and left leg

 Chest/ Precordial Leads:

It employs an exploring electrode to record the potential of the heart action on the chest in SIX different positions. They are also Unipolar leads.

These leads are represented by capital letter ‘C’ followed by a subscript numeral which represents the position of the electrodes on the pericardium.

C1- Fourth intercostal space to the right of Sternum

C2- Fourth intercostal space to the left of Sternum

C3- Midway between C2 and C4

C4- Fifth intercostal Space at Mid- clavicular line

C5- Same level as C4 on anterior axillary line

C6- Same level as C4 on Mid- axillary line

Three (3) lead ECG Electrode/Cable Placement:

 A 3-lead configuration requires the placement of three electrodes; one electrode adjacent each clavicle bone on the upper chest and a third electrode adjacent the patient's lower left abdomen. It is Typical Bipolar Lead form and Monitor reads as Lead I,II & III


                                      Fig (c) 3 lead ECG Placement


 Five (5) lead ECG Electrode/Cable Placement:

 A Five(5) lead configuration requires the placement of the three electrodes in the Three (3)-lead configuration with the addition of a fourth electrode adjacent to sternum (right side of Fourth intercostal space) and a fifth electrode on the patient's lower right abdomen. It is Bipolar Lead form and Monitor reads as Lead I,II & III along with Chest lead “C”

Fig : ( d ) 5 Lead ECG Placement


Six (6) lead ECG Electrode/Cable Placement:

 The 6 Lead ECG method consists of 6 electrodes including four limb and two chest electrodes. It can help us monitor Bipolar and augmented leads. The Ca and Cb should be placed in two of the positions of C1 to C6,The following combinations may be used C1&C3,C2&C5,C3&C5,C1&C4,C2&C4,C3&C6,C1&C5

Fig (e) 6 Lead ECG Placement


Ten (10) lead ECG Electrode/Cable Placement:

A 12-lead configuration requires the placement of 10 electrodes on the patient's body. Four electrodes, which represent the patient's limbs, include the left arm electrode (L lead), the right arm electrode (R lead), the left leg electrode (F lead), and the right leg electrode (N lead). Six chest electrodes (C1-C6 leads) are placed on the patient's chest at various parts. The recording consists of three Augmented Leads aVR,aVL & aVF, Three Bipolar leads Lead I,II,III and Six unipolar Precordial leads to complete the 12 channel ECG

Fig ( f ) 10 Lead ECG Placement


Summary : The above guide is to educate, inform and help the users, technicians in  placing the electrode/cable combination on human subject in a Simplified ideal way. Please feel free to respond back to us with suggestions to .


1 comment

  • Great information. Easy to understand to present for education.

    Vanessa Herron

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