Clinical utility of aVR-The neglected electrocardiographic lead.
BACKGROUND
Several studies suggest that electrocardiographers tend to neglect lead aVR during the reading of electrocardiograms (ECGs). Our objective was to provide a systematic review of the most important diagnostic and prognostic uses of lead aVR.


METHODS
We performed a thorough review of the literature about the lead aVR using PubMed, MEDLINE and the archives of the University at Buffalo libraries.


RESULTS
We found that lead aVR may provide important additional information in the diagnosis of coronary artery disease. It may provide a clue to the location of a lesion as well as the possibility of three vessel disease during an acute coronary syndrome. Lead aVR was found useful in the locus of arrhythmias and in differentiation of narrow and wide QRS complex tachycardias. It provides useful prognostic information for patients with the Brugada syndrome and tricyclic antidepressant toxicity. Lead aVR provides alternative criteria for the electrocardiographic diagnosis of left ventricular hypertrophy and left anterior fascicular block.


CONCLUSIONS
Lead aVR provides very important additional diagnostic and prognostic information in multiple cardiac conditions and can be used either alone or in conjunction with other electrocardiographic leads.
State University of New York at Buffalo, USA. dimonk5@yahoo.com <dimonk5@yahoo.com>
Dmitriy
D
Kireyev
Mikhail V
MV
Arkhipov
Stephen T
ST
Zador
Joseph A
JA
Paris
William E
WE
Boden
D000929:Antidepressive Agents, Tricyclic / Q000633:toxicity; D053840:Brugada Syndrome / Q000175:diagnosis; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D005080:Exercise Test; D006801:Humans; D017180:Tachycardia, Ventricular / Q000175:diagnosis
D000929:Antidepressive Agents, Tricyclic