Because adherence to this approach may be limited by lack of a visual landmark for the second ICS, we assessed an alternative technique.
The evaluated technique involved placement of the patient¡¯s hand up against the base of his/her neck (H¡úN maneuver) to help demarcate visually a specific point ¡°X¡± on the chest.
Of 112 patients studied, ¡°X¡± landed on the first rib in 2.7 % , first ICS in 7.1 % , second rib in 56.3 % , second ICS in 33.0 % , and third rib in 0.9 % . Thus, in 89.3 % (95 % confidence interval 83.6-95.0 % ) of cases (93.3 % of men, 84.6 % of women; p = 0.13), the second ICS could be identified by H¡úN via the following simple rule: Utilize ¡°X¡± if it overlies an ICS; or the immediately subjacent ICS if ¡°X¡± overlies a rib.
The H¡úN maneuver provides a primarily visual approach to identifying the second ICS and, thereby, the fourth ICS for affixing V1-V2. If the present initial experience is confirmed, H¡úN might merit consideration as an educational tool to promote anatomically correct placement of these precordial leads, a prerequisite to diminishing the incidence of ECG procedure-related ¡°septal ischemia/infarction.¡±