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Cardiology Teaching Package. ECG Lead Placement. The system of positioning of leads for performing a 12-lead ECG is universal. This helps to ensure that, when a person's ECGs are compared, any changes on the ECG are due to cardiac injury, not a difference in placement of leads, this is extremely important with the increasing use of foreign travel.
1 Often this is the lead with the smallest QRS. 2  The QRS axis is perpendicular to that lead's orientation (see above diagram). 3  Since there are two perpendiculars to each isoelectric lead, chose the perpendicular that best fits the direction of the other ECG leads.