Evaluation of electrocardiographic leads for detection of atrial activity (P wave) in ambulatory ECG monitoring: a pilot study.
The usual lead systems for ambulatory ECG monitoring (AECG) used in the evaluation of arrhythmias is a modified bipolar V-1 and V-5. A comparison of various lead systems to enhance the detection of atrial activity (p waves) has not been reported. We evaluated various surface lead systems in 12 subjects comparing p waves recorded at 20 mm/mV and 50 mm/sec. We compared p wave area, amplitude, and duration from modified bipolar V1 and V5 as well as seven nonstandard leads recorded on a AECG monitor. Of the seven nonstandard leads, a vertical sternal lead, with the negative pole just below the suprasternal notch and the positive pole at the xiphoid process, had the largest area (1.46 +/- 0.65 mm2), and also had a greater area than the standard V1 (0.88 +/- 0.45 mm) and V5 (1.06 +/- 0.49 mm2) lead system (P less than 0.01). We conclude that the bipolar vertical sternal lead system provides a larger p wave area than seven nonstandard bipolar lead systems and the two standard lead systems currently used in AECG monitoring. Replacement of the modified bipolar V1 lead with a vertical sternal lead should improve the recognition of atrial activity and, therefore, enhance the diagnosis of cardiac arrhythmias.
Department of Internal Medicine, University of Arizona, College of Medicine, Tucson.
L R
LR
Herzog
F I
FI
Marcus
W A
WA
Scott
L H
LH
Faitelson
P
P
Ott
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E
Hahn
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D016275:Atrial Function / Q000502:physiology*; D015716:Electrocardiography, Ambulatory / Q000379:methods*; D004566:Electrodes; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects