Lewis Lead Enhances Atrial Activity Detection in Wide QRS Tachycardia

Holanda-Miranda, Wallace Rodrigues de; Furtado, Felipe Magalhães; Luciano, Paula Menezes; Pazin‐Filho, Antônio

doi:10.1016/j.jemermed.2009.08.057

Cited by 10 publications

(2 citation statements)

References 7 publications

(10 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…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%

See 1 more Smart Citation

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

Cunningham

Borne

2020

JAMA Intern Med

View full text Add to dashboard Cite

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?

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Cunningham

Borne

2020

JAMA Intern Med

View full text Add to dashboard Cite

show abstract

The Lewis Lead for Detection of Ventriculoatrial Conduction Type

Huemer

Meloh

Attanasio

et al. 2016

Clinical Cardiology

View full text Add to dashboard Cite

Background: Identification of a possible ventriculoatrial (VA) dissociation in wide QRS complex tachycardias is one of the most reliable criteria for differentiation of tachycardia origin. The Lewis lead has been proposed for detection of atrial activity during ventricular tachycardias. Hypothesis: A modified Lewis-lead-ECG will be superior to the standard-lead ECG for detection of ventriculoatrial conduction during ventricular tachycardia. Methods: Forty-seven patients underwent electrophysiological study, stimulated with a fixed cycle length of 400 ms in the ventricle. During stimulation, a standard-lead ECG and a modified Lewis-lead ECG were recorded. Simultaneously, VA conduction was documented by intracardiac electrograms. Surface ECGs were presented to 6 blinded examiners for VA conduction assessment. Results: Type of VA conduction was correctly diagnosed in significantly more ECGs in the Lewis-lead ECG group (mean, 35.0 [75%]) than in the standard-lead ECG group (mean, 29.2 [62%]; P = 0.045). Ventriculoatrial dissociation also was significantly more often correctly diagnosed in the Lewis-lead ECG group (mean, 17.7 [71%]) than in the standard-lead ECG group (mean, 12.7 [49%]; P = 0.014). Interobserver agreement was moderate in both groups (κ = 0.45 and κ = 0.49, respectively). Conclusions: Compared with standard-lead ECG, modified Lewis-lead ECG is associated with significantly improved detection of VA conduction type during fast ventricular pacing and thus may help improve ECG diagnosis.

show abstract