The low-voltage electrocardiogram (ECG) is associated with various cardiac and noncardiac conditions as well as lead wire reversals and other electronic equipment problems. Low-voltage QRS in the ECG creates problems with continuous cardiac monitoring, such as false lethal arrhythmia alarms at central monitoring stations, and general false alarms, thus contributing to alarm fatigue. The ECG challenge for this issue is to examine the physiological, anatomical, and electrical equipment problems of low-voltage, or low-amplitude, ECG and to suggest methods for troubleshooting the low-voltage ECG to ensure reliable cardiac monitoring.

QRS amplitude varies through the lifespan, tends to be greater in males than in females, and is subject to a wide range of individual variations.1  QRS voltage is measured from the nadir of the QRS complex to its peak. Low-voltage ECG is usually defined as a QRS amplitude of 5 mm (0.5 mV) or less in all of the frontal plane...

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