The standard 11-lead ECG. Neglect of lead aVR in the classical limb lead display.


Journal Article

This study investigates how the format of limb lead display influences electrocardiographic (ECG) interpretation. The positive aspect of lead aVR (included in the classical display) is directed opposite to that of the other leads. This could lead to an ECG interpreter's disregard of lead aVR, thus providing a "standard 11-lead ECG." It is hypothesized that when using the classical limb lead display, ECG interpreters often ignore lead aVR, even when considering complex ECGs. Thirty-five of the participants attending this International Society of Computerized Electrocardiology meeting were asked to interpret five complex ECGs, displayed in the classical format. Lead aVR had been replaced by lead -aVR on all of these recordings. Second, the participants were asked if they (1) used all 12 leads, (2) used lead aVR, and (3) noticed that lead aVR had been changed. The results indicate that a vast majority of interpreters (80-94%) did not detect when lead aVR had been reversed. This suggests that interpreters only use 11 of the standard leads when presented with the classical display method to evaluate clinical problems.

Full Text

Cited Authors

  • Pahlm, US; Pahlm, O; Wagner, GS

Published Date

  • January 1, 1996

Published In

Volume / Issue

  • 29 Suppl /

Start / End Page

  • 270 - 274

PubMed ID

  • 9238411

Pubmed Central ID

  • 9238411

Electronic International Standard Serial Number (EISSN)

  • 1532-8430

International Standard Serial Number (ISSN)

  • 0022-0736

Digital Object Identifier (DOI)

  • 10.1016/s0022-0736(96)80074-4


  • eng