LAUSR

Dear Editor, The correct placement of V1 and V2 pericordial leads of the electrocardiogram (ECG) is on the fourth intercostal space to the right and the left margins of the sternum (Walsh, 2020). Misplacement of V1 and V2 leads where leads are placed higher than the fourth intercostal space is a common technical error in clinical practice (Walsh, 2018). Unfortunately, this has a negative impact on ECG interpretation as it could generate few falsepositive findings such as old septal myocardial infarction (MI), acute anterior STsegment elevation myocardial infarction (STEMI) pattern, and incomplete right bundle branch block (RBBB) (Walsh, 2018). The misinterpretation of the false ECG findings could lead to unnecessary medical management and intervention (Ilg and Lehmann, 2012). Interestingly, the morphology of P wave in V1 and V2 is a key factor which could help the physicians to differentiate between leads misplacement and true ECG findings. When V1 and V2 leads are placed correctly, in majority of healthy individuals P wave in V1 has a biphasic morphology (Walsh, 2020), whereas in V2 the shape of P wave is expected to be upright (Ilg and Lehmann, 2012). When V2 lead is placed higher than the fourth intercostal space, the positive amplitude of the P wave in V2 can be lost, and abnormal P wave shapes can be observed, such as flat, biphasic, and negative P waves based on the degree of the lead misplacement (Ilg and Lehmann, 2012). Furthermore, a predominantly negative P wave in V1 should raise the suspicion of V1 and V2 leads misplacement (GarcíaNiebla et al., 2012).