Precordial lead placement

To record a 12-lead ECG, place electrodes on the patient’s arms and left leg and place a ground lead on
the patient’s right leg. The three standard limb leads (I, II, and III) and the three augmented leads (aVR,
aVL, and aVF) are recorded using these electrodes. Then, to record the precordial chest leads, place
electrodes as follows:

• V1—fourth intercostal space (ICS), right sternal border

• V2—fourth ICS, left sternal border

• V3—midway between V2 and V4

• V4—fifth ICS, left midclavicular line

• V5—fifth ICS, left anterior axillary line

• V6—fifth ICS, left midaxillary line. V1 V2 V3 V4 V5 V6

Right precordial lead placement

Right precordial leads can provide specific information about the function of the right ventricle. Place
the six leads on the right side of the chest in a mirror image of the standard precordial lead placement,
as follows:

V1R—fourth ICS, left sternal border

V2R—fourth ICS, right sternal border

V3R—halfway between V2R and V4R

V4R—fifth ICS, right midclavicular line

V5R—fifth ICS, right anterior axillary line V6R—fifth ICS, right midaxillary line. Midclavicular line Anterior
axillary line Midaxillary line V6R V5R V4R V3R V2R V1R

Posterior lead placement Posterior leads can be used to assess the posterior side of the heart. To ensure
an accurate reading, make sure the posterior electrodes V7, V8, and V9 are placed at the same
horizontal level as the V6 lead at the fifth intercostal space. Place lead V7 at the posterior axillary line,
lead V9 at the paraspinal line, and lead V8 halfway between leads V7 and V9.