Pediatric Cardiology Center of Oregon (PCCO) has been at the forefront of medical care for children and adults with congenital heart disease since first opening its doors in 1986.

PCCO’s pediatric heart program has pioneered important advances in the treatment of congenital heart disease. Plus, our affiliation with Legacy Emanuel Hospital and the Randall Children’s Hospital means that our patients receive first-rate care in a state-of-the-art building designed and built specifically to promote a healing environment for children.

As part of our continuing effort to educate the broader community about our medical services and best practices for treating children with congenital heart disease, we thought we’d take a moment to go over the basics of pediatric ECG lead placement. 

Pediatric ECG Lead Placement

Americans may be more familiar with the acronym “EKG” (which derives from the German Elektrokardiogramm), but most medical practitioners use “ECG” (electrocardiogram) for the process of recording the heart’s electrical activity using electrodes.

The electrodes are placed at specific points on the patient’s skin in order to detect electrical changes in the heart that may indicate cardiac problems.

It’s the placement of the ECG leads (labeled with a V) that we’re focusing on here.

(Quick note: At PCCO, we follow adult guidelines for pediatric patients weighing 90 pounds or more. See below for infants, toddlers, and children weighing less than 90 pounds.)

ECG Basics

• V1 4th intercostal space to the right of the sternum (about ½ inch to 1 inch from the midline)
• V2 4th intercostal space to the left of the sternum (about ½ inch to 1 inch from the midline)
• V3 Midway between V2 and V4
• V4 5th intercostal space at the midclavicular line (at the nipple line)
• V5 Anterior axillary line at the same level as V4 (where the ribs curve back)
• V6 Midaxillary line at the same level as V4 and V5 (should be below the armpit) 

Extra Pediatric Leads for 15 Lead

Right side of chest:

• V3R Midway between V1 and V4R
• V4R 5th intercostal space at the midclavicular line (about nipple line)

Left side of chest:

• V7 after V6

For infants, toddlers, and children under 90 lbs, measuring rib spaces is not usually possible.

• V1 Nipple line to the right of the sternum (about ½ inch from the midline)
• V2 Nipple line to the left of the sternum (about ½ inch from the midline)
• V3 Midway between V2 and V4
• V4 Below the nipple at the midclavicular line
• V5 Anterior axillary line at the same level as V4 (about where the ribs curve back)
• V6 Midaxillary line at the same level as V4 and V5 (should be below the armpit)

Extra Pediatric Leads for 15 Lead

Right side of chest:

V3R Midway between V1 and V4R

V4R Below the nipple at the midclavicular line

Left side of chest:

V7 after V6

For all ECGs, limb leads should be placed on the limbs — not the torso.

Arm leads should be placed just above the elbows.

Leg leads should be placed between the knee and ankle.

One final tip: If computer interpretation reads “Right Superior Axis Deviation” or “Northwest Axis,” be sure to check the limb leads. 

Pediatric Cardiology Center of Oregon

PCCO operates outreach clinics throughout Oregon and Southwest Washington, so we’re never too far away.

Contact Pediatric Cardiology Center of Oregon for more information on our world-class pediatric care and to find a location near you.