Comparison of standard and Lewis ECG in detection of atrioventricular dissociation in patients with wide QRS tachycardia

Aksu, Uğur; Kalkan, Kamuran; Gülcü, Oktay; Topçu, Selim; Sevimli, Serdar; Aksakal, Enbiya; İpek, Emrah; Açıkel, Mahmut; Tanboğa, İbrahi̇m Hali̇l

doi:10.1016/j.ijcard.2016.09.087

Cited by 2 publications

(3 citation statements)

References 16 publications

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“…Indeed, the Lewis lead has proven invaluable in conclusively diagnosing ventricular tachycardia and in visualizing fibrillation waves in real-world clinical scenarios involving humans. [7][8][9][22][23][24] The present study shows that M 6 M 1 and M 6 M 2 exhibit a high atrial-to-ventricular amplitude ratio; the enhancement of atrial activity is achieved at a reduced ventricular amplitude and increased atrial amplitude. This finding is similar to a previous study 22 of the modified Lewis lead system; hence, M 6 M 1 and M 6 M 2 could specifically observe atrial activity as well.…”

Section: Discussionmentioning

confidence: 89%

A new bipolar precordial electrocardiographic lead configuration for specific evaluation of atrial depolarization in healthy dogs

Kurogochi,

Orito,

Uechi

2023

ajvr

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OBJECTIVE The Lewis lead is an EGC configuration used to detect atrial activity and its relationship with ventricular activity. However, no equivalent configuration has been proposed in veterinary medicine. Therefore, this study explored new bipolar lead configurations to evaluate atrial depolarization and investigated their characteristics by comparing them with conventional leads. The authors hypothesized that a lead with a high absolute value of the P wave (|P|) and a high ratio of the P wave to the QRS complex (|P|/|QRS|) might be an appropriate configuration. ANIMALS 6 laboratory Beagles were used. PROCEDURES Electrocardiograms were recorded using bipolar limb leads (I, II, III, aVL, aVF, and aVR) and unipolar precordial leads (C2, C3, C4, C5, C6, M1, M2, M5, M6, 1st-R, CV6LL, and V10) in the standing position. The new bipolar leads were attached in the following configuration: the negative electrode was attached to M6, and the positive electrode was sequentially applied to M1 and M2. The leads were named M6M1 and M6M2. RESULTS The waveforms obtained using the new bipolar leads M6M1 and M6M2 showed significantly higher |P|/|QRS| and |P| values than those obtained using conventional limb leads and precordial leads. CLINICAL RELEVANCE The new leads achieved a specific enhancement of atrial activity conducted at a reduced ventricular amplitude and increased atrial amplitude, similar to the Lewis lead in human medicine. These findings suggest that M6M1 and M6M2 could be supplemental lead configurations to identify P waves without amplifying the QRS waves compared to conventional methods.

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Section: Discussionmentioning

confidence: 89%

A new bipolar precordial electrocardiographic lead configuration for specific evaluation of atrial depolarization in healthy dogs

Kurogochi,

Orito,

Uechi

2023

ajvr

View full text Add to dashboard Cite

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“…The magnification of P waves partially buried in widened QRS complexes allows for more reliable identification of AV dissociation in ventricular tachycardia. [4][5][6][7] We successfully used the Lewis lead configuration to diagnose atrial flutter in a patient whose initial ECG was mislabeled as sinus tachycardia, the hypothesis being that the left pleural effusion resulted in low P-wave amplitude on the standard ECG. Placing the limb leads to the right of the sternum magnified the atrial activity by focusing the vectors across the atria.…”

Section: Discussionmentioning

confidence: 99%

“…Recent literature indicates the utility of the Lewis lead in the identification of AV dissociation to confirm the ventricular origin of wide complex tachycardias. The magnification of P waves partially buried in widened QRS complexes allows for more reliable identification of AV dissociation in ventricular tachycardia . We successfully used the Lewis lead configuration to diagnose atrial flutter in a patient whose initial ECG was mislabeled as sinus tachycardia, the hypothesis being that the left pleural effusion resulted in low P-wave amplitude on the standard ECG.…”

Section: Discussionmentioning

confidence: 99%

Looking Back to Find the Missing P Wave and Diagnose a Narrow Complex Tachycardia

Cunningham

Borne

2020

JAMA Intern Med

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A woman in her 80s with a history of non-small cell lung cancer presented to the emergency department with 1 week of fatigue, dyspnea on exertion, and increasing lower extremity edema. On arrival, she was afebrile; her heart rate was 125 beats/min; her respiratory rate was 24 breaths per minute; and her blood pressure was 147/95 mm Hg. On examination, her jugular venous pressure was elevated at 14 cm. Lung auscultation revealed decreased left lower lobe breath sounds. Cardiac examination was notable for revealing tachycardia, regular rhythm, and a 2/6 holosystolic murmur heard at the apex. Lower extremity examination revealed 1+ bilateral pitting edema. Laboratory evaluation revealed a mild anemia, and renal function and thyroid studies were normal. Results of chest radiography showed a large leftsided pleural effusion. Two electrocardiograms (ECGs) were obtained (Figure).Questions: What is the difference in lead placement between the ECGs in panels A and B of the Figure? What is the underlying arrhythmia?

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Comparison of standard and Lewis ECG in detection of atrioventricular dissociation in patients with wide QRS tachycardia

Cited by 2 publications

References 16 publications

A new bipolar precordial electrocardiographic lead configuration for specific evaluation of atrial depolarization in healthy dogs

A new bipolar precordial electrocardiographic lead configuration for specific evaluation of atrial depolarization in healthy dogs

Looking Back to Find the Missing P Wave and Diagnose a Narrow Complex Tachycardia

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