Ventricular Tachycardia

Williams, Craig D.

doi:10.1001/archinte.1943.00210020003001

“…DIscuSSION The special chest leads used in this study often display larger auricular waves than the standard leads, and thus help the interpretation of records showing abnormal rhythms. Auricular lead F appears to be superior to auricular lead R. Though Wood and Selzer (1939) stated that the right arm was the better distal electrode for the study of auricular activity, it is open to question whether their results can be directly compared with ours because they used a different technique, placing the exploring electrode in the fourth intercostal space at the right sternal border (leads CR1 and CF1). In ten unselected cases we studied the P waves in both auricular leads R and F, and in leads CR1 and CFI; the comparative figures are shown in Table I.…”

Section: Sinus Rhythmmentioning

confidence: 80%

“…He failed to notice any close relationship between the size of the right auricle and the amplitude of the P waves. Williams and Ellis (1943) used special auricular precordial leads in their study of ventricular tachycardia: they placed the exploring electrode in the third intercostal space at the right sternal border, using first the right arm and then the left leg for the indifferent electrode; they stated that these leads have repeatedly clarified an otherwise doubtful diagnosis. Barker et al (1943) suggested that in cases in which the P waves are small or indistinct in the standard leads, chest leads might prove helpful; in their opinion, by leading from two precordial contacts, one over the upper part of the sternum and the other over the ensiform process, it is usually possible to record large auricular waves.…”

mentioning

confidence: 99%

Chest leads for the demonstration of auricular activity

1945

American Heart Journal

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In certain forms of disorder of rhythm,. the correct electrocardiographic diagnosis depends to a great extent on the proper demonstration and interpretation of the activity of the auricles. This is especially the case in paroxysmal tachycardia. However, it is often very difficult with the usual leads to identify the auricular wave and to ascertain its relation to the ventricular deflection, because it may be very small and obscured by the QRS complex or the T wave. Attempts have been made, therefore, to devise special leads in order to obtain large auricular deflections. In this respect, the oesophageal lead (Brown, 1936;Deglaude and Laubry, 1939) is undoubtedly the best method at present, but in view of the hardship it imposes on the patient it can only be used in selected cases and certainly not in routine clinical cardiography. The purpose of this paper is to assess the value of special chest leads employed in this department during the last year in a number of cases, which were under the care of Professor Hume, upon the assumption that they would show auricular waves to much better advantage than the routine leads. I first became interested in this problem in 1940 during my visits to the Cardiac Department of the London-Hospital. Dr. William Evans showed me how clearly the auricular waves in various arrhythmias were demonstrated in chest leads and called my attention to this method of investigation. Lewis (1910) was the first to use special chest leads to facilitate the study of auricular waves. He noticed in cases of auricular fibrillation that the auricular oscillations were maximal when the electrodes were placed over the right auricle. He pointed out that the chest leads as used by him were especially helpful in cases with an enlarged right auricle, for in these cases a larger area of the auricular wall was in apposition to the chest wall. Drury and Iliescu (1921) found that coarse auricular oscillations in auricular fibrillation were more continuously present in the chest leads than in the limb leads. They used two chest leads, sternal and antero-posterior, for the demonstration of auricular activity. In the sternal lead, one electrode at the junction of the second right rib with the sternum was paired with another over the seventh right costal cartilage; in the antero-posterior lead, one electrode was placed on the centre of the sternum, and the other on the back at the level of the inferior angle of the scapula, two inches to the right of the vertebral column. Holzman (1937) observed that the largest auricular deflections in the chest leads occurred when the exploring electrode was placed to the right of the sternum.Lian and Pinchenzon (1938) studied the auricular rhythm in the " precordial auricular lead S 5 ": in this lead, one electrode over the manubrium sterni was paired with another in the fifth right intercostal space. Schoenewald (1939) was able to obtain clearer P waves than those in lead II, by leading off from the right border of the sternum, at the level of the third intercostal space, t...

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“…The method of taking special chest leads was that adopted by Schoenewald (1939), Faulkner (1943, and Williams and Ellis (1943). A circular electrode, 1 8 cm.…”

Section: Methodsmentioning

confidence: 99%

“…He failed to notice any close relationship between the size of the right auricle and the amplitude of the P waves. Williams and Ellis (1943) used special auricular precordial leads in their study of ventricular tachycardia: they placed the exploring electrode in the third intercostal space at the right sternal border, using first the right arm and then the left leg for the indifferent electrode; they stated that these leads have repeatedly clarified an otherwise doubtful diagnosis. Barker et al (1943) suggested that in cases in which the P waves are small or indistinct in the standard leads, chest leads might prove helpful; in their opinion, by leading from two precordial contacts, one over the upper part of the sternum and the other over the ensiform process, it is usually possible to record large auricular waves.…”

mentioning

confidence: 99%

Chest Leads for the Demonstration of Auricular Activity

Szekely

¹

1944

Heart

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In certain forms of disorder of rhythm,. the correct electrocardiographic diagnosis depends to a great extent on the proper demonstration and interpretation of the activity of the auricles. This is especially the case in paroxysmal tachycardia. However, it is often very difficult with the usual leads to identify the auricular wave and to ascertain its relation to the ventricular deflection, because it may be very small and obscured by the QRS complex or the T wave. Attempts have been made, therefore, to devise special leads in order to obtain large auricular deflections. In this respect, the oesophageal lead (Brown, 1936;Deglaude and Laubry, 1939) is undoubtedly the best method at present, but in view of the hardship it imposes on the patient it can only be used in selected cases and certainly not in routine clinical cardiography. The purpose of this paper is to assess the value of special chest leads employed in this department during the last year in a number of cases, which were under the care of Professor Hume, upon the assumption that they would show auricular waves to much better advantage than the routine leads. I first became interested in this problem in 1940 during my visits to the Cardiac Department of the London-Hospital. Dr. William Evans showed me how clearly the auricular waves in various arrhythmias were demonstrated in chest leads and called my attention to this method of investigation. Lewis (1910) was the first to use special chest leads to facilitate the study of auricular waves. He noticed in cases of auricular fibrillation that the auricular oscillations were maximal when the electrodes were placed over the right auricle. He pointed out that the chest leads as used by him were especially helpful in cases with an enlarged right auricle, for in these cases a larger area of the auricular wall was in apposition to the chest wall. Drury and Iliescu (1921) found that coarse auricular oscillations in auricular fibrillation were more continuously present in the chest leads than in the limb leads. They used two chest leads, sternal and antero-posterior, for the demonstration of auricular activity. In the sternal lead, one electrode at the junction of the second right rib with the sternum was paired with another over the seventh right costal cartilage; in the antero-posterior lead, one electrode was placed on the centre of the sternum, and the other on the back at the level of the inferior angle of the scapula, two inches to the right of the vertebral column. Holzman (1937) observed that the largest auricular deflections in the chest leads occurred when the exploring electrode was placed to the right of the sternum.Lian and Pinchenzon (1938) studied the auricular rhythm in the " precordial auricular lead S 5 ": in this lead, one electrode over the manubrium sterni was paired with another in the fifth right intercostal space. Schoenewald (1939) was able to obtain clearer P waves than those in lead II, by leading off from the right border of the sternum, at the level of the third intercostal space, t...

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Diseases of the Heart

Williams¹

1944

Arch Intern Med (Chic)

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Ventricular Tachycardia

Cited by 48 publications

References 26 publications

Chest leads for the demonstration of auricular activity

Chest leads for the demonstration of auricular activity

Chest Leads for the Demonstration of Auricular Activity

Diseases of the Heart

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