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Review
. 2024 Sep 13;24(18):5947.
doi: 10.3390/s24185947.

Clinical Utility of Synthesized 18-Lead Electrocardiography

Tetsushi Yamamoto  1 , Hiroyuki Awano  2 , Shuichiro Ogawa  1 , Masafumi Matsuo  3
Affiliations
Review

Clinical Utility of Synthesized 18-Lead Electrocardiography

Tetsushi Yamamoto et al. Sensors (Basel). .

Abstract

Eighteen-lead electrocardiography (18-ECG) includes, in addition to those in standard 12-lead ECG (12-ECG), six additional chest leads: V7-V9 and V3RV5R. Leads V7-V9 require the patient to be in a lateral decubitus position for the electrodes to be attached to the back. Synthesized 18-ECG (syn18-ECG) is a method that only records 12-ECG and uses computational logic to record the posterior wall (V7-V9) and right-sided (V3R-V5R) leads. We review the clinical utility of syn18-ECG in conditions including acute coronary syndromes, arrhythmias, acute pulmonary embolism, and Duchenne muscular dystrophy. The syn18-ECG waveform correlates well with the actual 18-ECG waveform, indicating that syn18-ECG is an excellent substitute for 18-ECG, excluding negative T waves. ST elevation in leads V7-V9 has the effect of reducing missed acute coronary syndromes in the posterior wall. In cases of arrhythmia, syn18-ECG can accurately estimate the target site of radiofrequency catheter ablation using a simple algorithm. The use of additional leads in Duchenne muscular dystrophy is expected to provide new insights. To facilitate gaining more knowledge regarding diseases that have not yet been investigated, it is imperative that the cost of syn18-ECG is reduced in the future.

Keywords: Duchenne muscular dystrophy; acute coronary syndromes; acute pulmonary embolism; arrhythmias; synthesized 18-lead electrocardiography.

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Conflict of interest statement

M.M. is an advisor for JCR Pharmaceuticals Co., Ltd., Japan, and Daiichi Sankyo Co., Ltd. H.A. received consulting fees from Daiichi Sankyo Co., Ltd., Nippon Shinyaku Co., Ltd., and Takeda Pharmaceutical Co., Ltd., and lecture fees from Nippon Shinyaku Co., Ltd., Chugai Pharmaceutical Co. Ltd., Biogen Japan Ltd., Pfizer Japan Inc., and JCR Pharmaceuticals Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

Figure 1
Figure 1
Positioning of chest electrodes and heart in 18-ECG chest electrode in horizontal cross-section. White: Electrodes of a standard 12-ECG; Red and blue: Electrodes added in 18-ECG; LV: left ventricular; LA: left atrium; RV: right ventricular; RA: right atrium.
Figure 2
Figure 2
Additional chest electrode attachment sites: (a) precordial lead site; (b) electrode position on the left rear section.
See this image and copyright information in PMC

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