The classical versus the Cabrera presentation system for resting electrocardiography: Impact on recognition and understanding of clinically important electrocardiographic changes

Lam, Anny; Wagner, Galen S.; Pahlm, Olle

doi:10.1016/j.jelectrocard.2015.05.011

Cited by 13 publications

(9 citation statements)

References 34 publications

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“…ECG was done in supine position. ECG parameters were measured using Minnesota code [9], by two independent persons and their final judge was achieved by consensus in case of disagreement.…”

Section: All Of the Patients Have Undergone Electrocardiography (Ecg)mentioning

confidence: 99%

“…The P-value axis and QRS complex were calculated by Cabrera system [9]. The following parameters were followed: high, peaked P wave≥2,5mm height in leads II, III, aVF; right ventricular hypertrophy (RVH)-right axis deviation of +110° or more; dominant R wave in V1 (> 7mm tall or R/S ratio > 1); dominant S wave in V5 or V6 (> 7mm deep or R/S ratio < 1); QRS duration < 120ms); LBBB (left bundle branch block: the QRS duration ≥ 120 ms, QS or rS complex in lead V1, notched ('M'-shaped) R wave in lead V6), incomplete right bundle branch block (RBBB)(RSR' pattern in V1-3 with QRS duration < 120ms), abnormal transitional zone (poor R-wave progression or "poor anterior R-wave progression"), S1S2S3 pattern (presented with S waves in leads I, II and III and negative T-wave changes in V1-V3).…”

Section: All Of the Patients Have Undergone Electrocardiography (Ecg)mentioning

confidence: 99%

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Electrocardiographic predictors of five-years mortality in chronic obstructive pulmonary disease patients

et al. 2021

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Introduction/Objective. Cardiovascular disease is one of the most common comorbidities among subjects with chronic obstructive pulmonary disease (COPD). The aim of this study is to evaluate ECG parameters and mortality predictors in COPD patients. Methods. A total of 835 consecutive patients were included. Patients were classified to suffer from COPD if in three consecutive postbronhodilatator measurements FEV1/FVC was <70%. Following ECG changes were observed: axis, p wave, low ORS complex, transitional zone, left bundle branch block (LBBB), right bundle branch block (RBBB), incomplete right bundle branch block, S1S2S3 configuration, negative T in V1-V3. Patients were followed up for mortality in a five years period. Results. Both survivors and non-survivors were similar age, gender and COPD status. FVC and FEV1 as well as GOLD stadium are significantly higher in surviving group (p<0.016, p<0.001, p<0.001 respectively). Normal axis was in significantly higher percentage in non-survived patients (p=0.020). Right RBBB and incomplete RBB are more frequent finding in patients who died as (p?0.001, p?0.05, respectively). LBBB, S1S2S3 configuration is in significantly higher percent in non survivors (p<0.016, p<0.001, respectively). In multivariable logistic model, patients with LBBB have two times higher chance of mortality compared to patients without LBBB. Contrary, patients with RBBB have 1.6 times lower chance to have death outcome. Conclusion. Main ECG predictors of COPD patients? five-year mortality are LBBB and RBBB, but according to statistical model, electrocardiogram should be further explored and possibly obligatory involved in a routine clinical practice as an easy and low-cost screening method.

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“…ECG was done in supine position. ECG parameters were measured using Minnesota code [9], by two independent persons and their final judge was achieved by consensus in case of disagreement.…”

Section: All Of the Patients Have Undergone Electrocardiography (Ecg)mentioning

confidence: 99%

Section: All Of the Patients Have Undergone Electrocardiography (Ecg)mentioning

confidence: 99%

Electrocardiographic predictors of five-years mortality in chronic obstructive pulmonary disease patients

et al. 2021

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“…After the introduction of the Cabrera display in the 1950’s [45] several authors have recommended its use [46–51]. This display has been promoted in a position paper in the Journal of Electrocardiology [52], and was included as an appropriate alternative to the standard display in the recommendations for standardization of the electrocardiogram (2009) endorsed by both the American Heart Association and the American College of Cardiology [53].…”

Section: Main Textmentioning

confidence: 99%

Why complicate an important task? An orderly display of the limb leads in the 12-lead electrocardiogram and its implications for recognition of acute coronary syndrome

Lindow

Birnbaum

Nikus

et al. 2019

BMC Cardiovasc Disord

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BackgroundIn the standard ECG display, limb leads are presented in a non-anatomical sequence: I, II, III, aVR, aVL, aVF. The Cabrera system is a display format which instead presents the limb leads in a cranial/left-to-caudal/right sequence, i.e. in an anatomically sequential order. Lead aVR is replaced in the Cabrera display by its inverted version, −aVR, which is presented in its logical place between lead I and lead II.Main textIn this debate article possible implications of using the Cabrera display, instead of the standard, non-contiguous lead display, are presented, focusing on its use in patients with possible acute coronary syndrome. The importance of appreciating reciprocal limb-lead ECG changes and the diagnostic and prognostic value of including aVR or lead −aVR in ECG interpretation in acute coronary syndrome is covered. Illustrative cases and ECGs are presented with both the standard and contiguous limb lead display for each ECG.A contiguous lead display is useful when diagnosing acute coronary syndrome in at least 3 ways: 1) when contiguous leads are present adjacent to each other, identification of ST elevation in two contiguous leads is simple; 2) a contiguous lead display facilitates understanding of lead relationships as well as reciprocal changes; 3) it makes the common neglect of lead aVR unlikely.ConlusionsIt is logical to display the limb leads in their sequential anatomical order and it may have advantages both in diagnostics and ECG learning.

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“…Our aim in this study is to fill this critical gap of knowledge by defining for the first time the three electrical heart axes in the frontal plane of live normal wild-type adult zebrafish. Specifically, we introduce the bipolar dual-lead ECG recording method to adult zebrafish to "reverse translate" an established clinical strategy for determining human frontal electrical heart axes based on Einthoven's triangle and the hexaxial Cabrera reference system (Lam et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Constructing Adult Zebrafish Einthoven’s Triangle to Define Electrical Heart Axes

et al. 2021

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Zebrafish is a popular high-throughput vertebrate model to study human cardiac electrophysiology, arrhythmias, and myopathies. One reason for this popularity is the purported striking similarities between zebrafish and human electrocardiograms (ECGs). However, zebrafish electrical heart axes were unknown. It is impossible to define heart axis based on single-lead ECG because determination of an electrical heart axis in the frontal plane requires the use of the hexaxial reference system (or Cabrera system) derived from Einthoven’s triangle. Construction of Einthoven’s triangle requires simultaneous ECG recording from at least two Einthoven bipolar leads. Therefore, we systematically constructed the first zebrafish Einthoven’s triangle by simultaneous bipolar dual-lead ECG recording to determine for the first time the three frontal electrical heart axes using the Cabrera system. Comparing zebrafish with human Einthoven’s triangle reveals that their normal frontal electrical axes were reflections of each other across 0° in the Cabrera system. The responsible mechanisms involve zebrafish vs. human cardiac activation propagating in the same direction along the heart horizontal axis but in opposite directions along the heart longitudinal axis. The same observations are true for zebrafish vs. human cardiac repolarization. This study marks a technical breakthrough in the first bipolar dual-lead ECG recording in live adult zebrafish to construct for the first time zebrafish Einthoven’s triangle. This first systematic analysis of the actual differences and similarities between normal adult zebrafish and human Einthoven’s triangles unmasked differences and similarities in the underlying cardiac axis mechanisms. Insights of the live adult zebrafish main heart axis and its three frontal electrical heart axes provide critical contextual framework to interpret the clinical relevance of the adult zebrafish heart as model for human cardiac electrophysiology.

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The classical versus the Cabrera presentation system for resting electrocardiography: Impact on recognition and understanding of clinically important electrocardiographic changes

Cited by 13 publications

References 34 publications

Electrocardiographic predictors of five-years mortality in chronic obstructive pulmonary disease patients

Electrocardiographic predictors of five-years mortality in chronic obstructive pulmonary disease patients

Why complicate an important task? An orderly display of the limb leads in the 12-lead electrocardiogram and its implications for recognition of acute coronary syndrome

Constructing Adult Zebrafish Einthoven’s Triangle to Define Electrical Heart Axes

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