Optimizing electrocardiograph electrode placement for cardiac-gated magnetic resonance imaging.

Electrocardiographs recorded in a magnetic field for cardiac-gating in magnetic resonance imaging (MRI) are complicated by blood flow-induced potentials. This study examines which lead of the standard 12-lead ECG maximizes the QRS while minimizing flow-induced interference. Twelve-lead ECGs were performed on normal volunteers (n = 9) and patients (n = 13) in and out of the bore of a 1.5 Tesla imaging magnet. The amplitude of the major flow-induced potentials was measured, and the vectors of largest induced potential and the QRS axis were plotted for each subject. ECGs obtained outside and inside the magnet were digitized and subtracted (in magnet ECG--out of magnet ECG = artifact ECG) and the peaks of the resultant curves measured. Superimposed potentials were largest in the early T wave and late S-T segment in leads I, II, V1, and V2, and smallest in III and AVF. A low-amplitude 7-to 10-Hz signal occurred in most leads. In the frontal plane, QRS axes and flow potential vectors were closely clustered. In the transverse plane, QRS axes generally followed leads V5 or V6, whereas the flow potential vectors followed leads V1, V2, or V3. The normal and patient groups did not differ. Although leads III and AVP showed the smallest superimposed potentials, V5, V6, or a left posterior chest lead may maximize QRS and reduce artifact most consistently. A 7- to 10-Hz frequency filter may help eliminate artifacts in some subjects.