On the Einthoven Triangle: A Critical Analysis of the Single Rotating Dipole Hypothesis

Abstract

Since its inception, electrocardiography has been based on the simplifying hypothesis that cardinal limb leads form an equilateral triangle of which, at the center/centroid, the electrical equivalent of the cardiac activity rotates during the cardiac cycle. Therefore, it is thought that the three limbs (right arm, left arm, and left leg) which enclose the heart into a circuit, where each branch directly implies current circulation through the heart, can be averaged together to form a stationary reference (central terminal) for precordials/chest-leads. Our hypothesis is that cardinal limbs do not form a triangle for the majority of the duration of the cardiac cycle. As a corollary, the central point may not lie in the plane identified by the limb leads. Using a simple and efficient algorithm, we demonstrate that the portion of the cardiac cycle where the three limb leads form a triangle is, on average less, than 50%.

Electromechanical Association as a Stemi Mimicry - Case Report

“…In Einthoven's triangle, right arm (RA) is always negative pole (-), left leg (LL) is always positive pole (+) and left arm (LA) could be positive or negative (14).…”

“…The GTC will also constitute the negative pole of unipolar precordial electrodes (14). Therefore, any disturbance in one arm electrode will affect all leads that include that culprit electrode, either directly or indirectly via the GCT (11).…”

Carbon nanotube materials for electrocardiography

“…Typical ECG equipment requires ten electrodes (12-lead ECG) connected to chest, arms and legs. 33 It should be emphasized that attaching such electrodes is time-consuming and can be performed only by a trained health-care professional and, obviously, it cannot be used by patients at home for long-term monitoring. Importantly, as patients could display only transient symptoms, ECG would not capture them during the standard ECG protocol and such problems would require the continuous ECG monitoring.…”

Soft Gel-free ECG electrodes based on Biocompatible Coconut-Oil and Carbon Black

“…Einthoven's 3-lead was used on the chest to record the ECG signals [22]. This configuration is commonly used to record the potential between both arms, and between the left leg and each arm, measuring a differential reading with respect to a neutral point, the left leg.…”