The first electrocardiogram is from lead II; it consists of irregularly placed ventricular complexes (R, T) and of large and continuous oscillations (f f).

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Thomas Lewis developed and described (1913) his lead configuration to magnify atrial oscillations present during atrial fibrillation.

Erhardt et al first described the use of a right sided precordial lead (CR4R or V4R) in the diagnosis of right ventricular infarction which had previously been thought to be electrocardiographically silent. [Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction. Am Heart J. 1976]

Great article. Question- 15-lead ECGs- here in NC there a trend of acquiring a 15-lead ECG, which essentially just moves V4, V5, and V6 to the other side of the chest. How valuable would this be as opposed to a right sided ECG using V3, V4, V5, and V6 on the right?

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Instead of regular leads I, II, and III there are now three bipolar chest leads that are termed FI, FII, and FIII which record the potentials developed in the right ventricle, from the infundibulum to the diaphragm.

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Fontaine bipolar precordial leads (F-ECG) are used to increase the sensitivity of epsilon wave detection. Named after French cardiologist and electrophysiolgist Guy Hugues Fontaine (1936-2018). Leads are placed as shown:

What is the point of moving the LL limb lead for monitoring the Lewis Lead, if we’re only monitoring lead I? It’s my understanding that the only leads being used by the machine in Lead I is RA, LA, and ground (RL).

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The ECG is one of the most useful investigations in medicine. Electrodes attached to the chest and/or limbs record small voltage changes as potential difference, which is transposed into a visual tracing

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The Lewis lead configuration can help to detect atrial activity and its relationship to ventricular activity. Named after Welsh cardiologist Sir Thomas Lewis (1881-1945) who first described in 1913. Useful in:

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When fibrillation is present and the electrodes lie in the vicinity of the right auricle (leads 1 and 2 of the diagram) the oscillations are maximal, and there is but a trace of the ventricular beats. When they lie in the long axis of the heart (lead 3) then both the oscillations and the ventricular complexes are conspicuous. Finally, when they lie along the left or right ventricular border (leads 4 and 5) the ventricular complexes are clear cut while the oscillations are small or absent.

The corresponding electrocardiograms are shown below the diagram, the first curve of which is from the customary lead II (right arm to left leg). The oscillations of fibrillation are readily identified in this manner and their origin in the auricle is clearly indicated. In tremulous subjects, no oscillations are seen in any of the special leads.

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