Toward self-validating ECG Systems: A personalized, uncertainty-aware approach for detecting and estimating lead misplacement

BACKGROUND Electrode positioning directly influences the interpretation and diagnostic quality of ECG recordings. While current solutions mainly focus on detecting lead swaps in standard full-lead configurations, the growing adoption of portable and reduced-lead devices underscores the need for effective methods to identify and quantify electrode misplacement in various settings. METHODS We developed and evaluated an end-to-end, personalized, uncertainty-aware framework that took ECG waveforms as input and automatically detected and estimated potential electrode misplacement, using an annotated dataset of 4608 Mayo Clinic 12-lead ECGs. The pipeline combined a deep convolutional encoder to identify the lead source area with a regression head that leveraged the learned representation to estimate misplacement direction and magnitude. It also incorporated patient-specific ECG morphology for personalization and integrated an uncertainty quantification mechanism based on Monte Carlo dropout to enhance decision confidence. RESULTS The proposed method achieved over 94% classification accuracy in detecting the lead source area and estimated lead misplacement with a mean absolute error (MAE) of 2.2 cm. Incorporating personalized information enhanced results, reaching 97.5% accuracy and an MAE of 2.0 cm, while also largely maintaining performance for ECG determinations such as myocardial infarction and atrial fibrillation. The uncertainty-aware layer further reduced false corrections by flagging unfamiliar or ambiguous cases, boosting accuracy to 98.6% and lowering the MAE to 1.8 cm. CONCLUSION This study introduced a practical solution to improve ECG lead placement accuracy, enabling self-validating lead positioning that can enhance diagnostic reliability and support broader adoption of ECG technology in both clinical and decentralized care.