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Non-Standard ECG Leads

Non-standard modified ECG leads

Standard 12-lead ECG

Standard 12 lead ECG, 10 ECG electrodes
  • Standard ECG has 10 electrodes
    • which are placed on the patient's body
  • On ECG paper there are 12 leads
    • which the ECG device generates from the 10 electrodes

  • 12 ECG leads "look" at the heart in 2 planes:
    • Horizontal (V1-V6)
    • Frontal (I, II, III, aVF, aVR, aVL)
  • All leads are oriented from the central terminal
  • If the electrical vector points
    • Toward the lead - a positive deflection occurs
    • Away from the lead - a negative deflection occurs


Non-standard ECG Leads


Modified Chest Lead

Modified Chest Lead, Marriotts Chest Lead, Modified Central Lead (MCL1)

5-Electrode System

ECG 5 electrode system

Leads V1 and V2 in the 6th Intercostal Space

ECG leads V1, V2, in 6th intercostal space, left anterior hemiblock, anterior infarction

Leads V1 and V2 in the 2nd Intercostal Space

ECG leads V1, V2, 2nd intercostal space, Brugada syndrome

Lewis Lead

ECG Lewis lead
  • Right Arm Electrode
    • Placed parasternal on the right in the 2nd intercostal space
  • Left Arm Electrode
    • Placed parasternal on the right in the 4th intercostal space
  • Calibration set to 20mm
  • Black Electrode (grounding)
    • Placed anywhere on the body

  • Lewis Lead effectively differentiates atrial activity:

Esophageal ECG

ECG esophageal recording electrode, atrial activity, ventricular activity

Posterior Leads (V7-V9)

ECG posterior leads, posterior STEMI, occlusion LCx (culprit vessel). V7 (left posterior axillary line), V8 (left midscapular line), V9 (left border of the spine)
  • Leads V4-V6 are removed and placed on the back on the left side
    • On the ECG recording, they are then labeled as (V7-V9)
  • Posterior leads (V7-V9) are positioned
    • at the level of lead V6 (5th intercostal space)
    • V7 (Left axillary line)
    • V8 (Scapular line - apex of the scapula)
    • V9 (Left paravertebral line)

  • Posterior leads are used for diagnosing

Right-Sided Leads (V4R-V6R)

ECG (V3R-V6R) right-sided leads, isolated RVMI, culprit vessel, ischemic electrical vector


Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers





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Home /

Non-Standard ECG Leads

Non-standard modified ECG leads

Standard 12-lead ECG

  • Standard ECG has 10 electrodes
    • which are placed on the patient's body
  • On ECG paper there are 12 leads
    • which the ECG device generates from the 10 electrodes

  • 12 ECG leads "look" at the heart in 2 planes:
    • Horizontal (V1-V6)
    • Frontal (I, II, III, aVF, aVR, aVL)
  • All leads are oriented from the central terminal
  • If the electrical vector points
    • Toward the lead - a positive deflection occurs
    • Away from the lead - a negative deflection occurs
Standard 12 lead ECG, 10 ECG electrodes

Non-standard ECG Leads


Modified Chest Lead
Modified Chest Lead, Marriotts Chest Lead, Modified Central Lead (MCL1)

5-Electrode System

  • Limbs electrodes (RA, LA, RL, LL)
    • Are placed at the ends of the limbs
    • The ECG device generates (I, II, III, aVL, aVF, aVR) from these
  • From the precordial electrodes, only V1 is used

  • The 5-electrode system effectively differentiates:
ECG 5 electrode system

Leads V1 and V2 in the 6th Intercostal Space
ECG leads V1, V2, in 6th intercostal space, left anterior hemiblock, anterior infarction

Leads V1 and V2 in the 2nd Intercostal Space

  • On a standard 12-lead ECG
    • Leads V1 and V2 are placed higher in the 2nd intercostal space

  • Leads V1 and V2 in the 2nd intercostal space effectively differentiate:
ECG leads V1, V2, 2nd intercostal space, Brugada syndrome

Lewis Lead

  • Right Arm Electrode
    • Placed parasternal on the right in the 2nd intercostal space
  • Left Arm Electrode
    • Placed parasternal on the right in the 4th intercostal space
  • Calibration set to 20mm
  • Black Electrode (grounding)
    • Placed anywhere on the body

  • Lewis Lead effectively differentiates atrial activity:
ECG Lewis lead

Esophageal ECG

  • Esophageal ECG Electrode
    • Inserted into the atrial area
    • Effectively displays atrial activity
  • A: represents atrial activity
  • V: represents ventricular activity
  • The amplitude of the ECG changes based on the height of the electrode in the esophagus
  • The electrode is connected with the electrodes on the right and left arms

  • Esophageal ECG effectively differentiates atrial activity:
ECG esophageal recording electrode, atrial activity, ventricular activity

Posterior Leads (V7-V9)

  • Leads V4-V6 are removed and placed on the back on the left side
    • On the ECG recording, they are then labeled as (V7-V9)
  • Posterior leads (V7-V9) are positioned
    • at the level of lead V6 (5th intercostal space)
    • V7 (Left axillary line)
    • V8 (Scapular line - apex of the scapula)
    • V9 (Left paravertebral line)

  • Posterior leads are used for diagnosing
ECG posterior leads, posterior STEMI, occlusion LCx (culprit vessel). V7 (left posterior axillary line), V8 (left midscapular line), V9 (left border of the spine)

Right-Sided Leads (V4R-V6R)

  • V3R-V6R are mirror-image thoracic leads V3-V6
  • The lead V4R directly views the right ventricle
    • The vector in right ventricular STEMI points towards lead V4R

  • Right-sided leads are used for diagnosing
ECG (V3R-V6R) right-sided leads, isolated RVMI, culprit vessel, ischemic electrical vector



Sources

  • ECG from Basics to Essentials Step by Step
  • litfl.com
  • ecgwaves.com
  • metealpaslan.com
  • medmastery.com
  • uptodate.com
  • ecgpedia.org
  • wikipedia.org
  • Strong Medicine
  • Understanding Pacemakers