Clinical utility of aVR - The neglected electrocardiographic lead

Annals of Noninvasive Electrocardiology

Volumn 15, Issue 2, 2010, Pages 175-180

  Kireyev, Dmitriy ^a   Arkhipov, Mikhail V ^b   Zador, Stephen T ^c   Paris, Joseph A ^a,d   Boden, William E ^a,d  

^a UNIVERSITY AT BUFFALO   (United States)

^b URAL STATE MEDICAL UNIVERSITY   (Russian Federation)

^c Buffalo Electrophysiology LLC   (United States)

^d BUFFALO GENERAL HOSPITAL   (United States)

Author keywords

Brugada syndrome; Coronary artery disease; Lead aVR; Narrow complex tachycardias; Tricyclic antidepressant toxicity; Wide complex tachycardias

Indexed keywords

TRICYCLIC ANTIDEPRESSANT AGENT;

ACUTE CORONARY SYNDROME; BRUGADA SYNDROME; CORONARY ARTERY DISEASE; DATA ANALYSIS; ELECTROCARDIOGRAM; HEART ARRHYTHMIA; HEART DISEASE; HEART LEFT VENTRICLE HYPERTROPHY; HUMAN; INFORMATION CENTER; LIBRARY; PRIORITY JOURNAL; PROGNOSIS; QRS COMPLEX; QT PROLONGATION; R WAVE; REVIEW; SIDE EFFECT; SINUS TACHYCARDIA; TACHYCARDIA; ELECTROCARDIOGRAPHY; EXERCISE TEST; PROCEDURES; TACHYCARDIA, VENTRICULAR;

ANTIDEPRESSIVE AGENTS, TRICYCLIC; BRUGADA SYNDROME; CORONARY ARTERY DISEASE; ELECTROCARDIOGRAPHY; EXERCISE TEST; HUMANS; TACHYCARDIA, VENTRICULAR;

EID: 77950875942     PISSN: 1082720X     EISSN: 1542474X     Source Type: Journal    
DOI: 10.1111/j.1542-474X.2010.00359.x     Document Type: Review

References (51)

1. Gorgels AP, Engelen DJ, Wellens HJ. Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography. J Am Coll Cardiol 2001 38 : 1355 1366.
2. Pahlm US, Pahlm O, Wagner GS. The standard 11-lead ECG: Neglect of lead aVR in the classical limb display. J Electrocardiol 1996 29 : 270 274. (Pubitemid 27051667)
3. Yan A T, Yan RT, Kennely, KM, et al. Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes. Am Heart J 2007 154 : 71 78. (Pubitemid 46920481)
4. 1. J Am Coll Cardiol 2001 38 : 1348 1354. (Pubitemid 33033009)
5. Vasudevan K, Manjunath CN, Srinivas KH, et al. Electrocardiographic localization of the occlusion site in left anterior descending coronary artery in acute anterior myocardial infarction. Indian Heart J 2004 56 : 315 319. (Pubitemid 39551544)
6. Engelen DJ, Gordels AP, Cheriex EC, et al. Value of the electrocardiogram in localizing of the occlusion site in the left anterior descending coronary artery in acute myocardial infarction. J Am Coll Cardiol 1999 34 : 389 395.
7. Hengrussanee K, Kehasukcharoen W, Tansuphaswadikul S. Significance of lead aVR ST segment elevation in acute coronary syndrome. J Med Assoc Thai 2005 88 : 1382 1387. (Pubitemid 43104383)
8. Aygul N, Ozdemir K, Tokac M, et al. Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and in-hospital outcome in ST-elevation myocardial infarction: An electrocardiographic predictor of poor prognosis. J Electrocardiol 2008 41 : 335 341.
9. Zhong-qun Z, Wei W, Chong-quan Q, et al. Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V3R, V1 or aVR: Electrocardiographic and angiographic correlations. J Electrocardiol 2008 41 : 329 334.
10. Rostoff PP, Piwowarska WW. ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome. Kardiol Pol 2006 64 : 8 14. (Pubitemid 44242155)
11. Tuna KM, Tolga KH, Tekin A, et al. Exersize-induced ST-segment elevation in leads aVR and V1 for the prediction of left main disease. Int J Cardiol 2008 128 : 240 243. (Pubitemid 352037462)
12. Rostoff PP, Wnuk M, Piwowarska W. Clinical significance of exercise-induced ST-segment elevation in lead aVR and V1 in patients with chronic stable angina pectoris and strongly positive exercise test results (in Polish). Pol Arch Med Wewn 2005 114 : 1180 1189.
13. 5. Int J Cardiol 1999 71 : 49 56.
14. Michaelides AP, Psomadaki ZD, Aigyptiadou MN, et al. Significance of exercise-induced ST changes in leads aVR, V5, and V1. Discrimination of patients with single- or multivessel coronary artery disease. Clin Cardiol 2003 26 : 226 230.
15. Tan SY, Myers J, Sandri M, et al. The prognostic value of T wave amplitude in lead aVR in males. Ann Noninvasive Electrocardiol 2008 13 : 113 119. (Pubitemid 351575177)
16. Verma VK, Alkeylani A. Can an upright T-wave in lead aVR be a clinical marker for underlying myocardial disease? Chest 2003 124 : 155S.
17. Kistler PM, Roberts-Thomson KC, Haqqani HM, et al. P wave morphology in focal atrial tachycardia: Development of an algorithm to predict the anatomical site of origin. J Am Coll Cardiol 2006 48 : 1010 1017.
18. Tada H, Nogami A, Naito S, et al. Simple electrocardiographic criteria for identifying the site of origin of focal right atrial tachycardia. Pacing Clin Electrophysiol 2006 21 : 2431 2439.
19. Kistler PM, Fynn SP, Haqqani H, et al. Focal Atrial Tachycardia from the ostium of coronary sinus: Electrocardiographic and electrophysiological characterization and radiofrequency ablation. J Am Coll Cardiol 2005 45 : 1488 1493. (Pubitemid 40615624)
20. Zhong YM, Guo JH, Hou AJ, et al. A modified electrocardiographic algorhythm for differentiating typical atrioventricular node reentrant tachycardia from atrioventricular reciprocating tachycardia mediated by concealed accessory pathway. Int J Clin Pract 2006 60 : 1371 1377.
21. Ho YL, Lin LY, Lin JL, et al. Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia. Am J Cardiol 2003 92 : 1424 1428.
22. Josephson ME, Localization of bypass tract. In Josephson ME (ed. Clinical Cardiac Electrophysiology: Techniques and Interpretations, 3d.
23. Rostock T, Sydow K, Steven D, et al. A new algorithm for concealed accessory pathway localization using T-wave subtracted retrograde P-wave polarity during orthodromic atrioventricular reentrant tachycardias. J Interv Electrophysiol 2008 22 : 55 63.
24. Kindwall KE, Brown J, Josephson ME. Electrocardiographic criteria for ventricular tachycardia in wide complex left bundle branch block morphology tachycardias. Am J Cardiol 1988 61 : 1279 1283.
25. Brugada P. Brugada J, Mont L, et al. A new approach to the differential diagnosis of regular tachycardia with wide QRS complex. Circulation 1991 83 : 1649 1659.
26. Edhouse J, Morris F. ABC of clinical electrocardiography. Broad complex tachycardia - Part I. BMJ 2002 324 : 719 722. (Pubitemid 34259149)
27. Vereckei A, Duray G, Szenasi G, et al. Application of a new algorithm in the differentiatial diagnosis of wide QRS complex tachycardia. Eur Heart J 2007 28 : 589 600. (Pubitemid 47355500)
28. Vereckei A, Duray G, Szenasi G, et al. New Algorithm using only lead aVR for differential diagnosis of wide QRS tachycardias. Heart Rhythm 2008 5 : 89 98.
29. Yoshida Y, Hirai M, Murakami Y, et al. Localization of precise origin of idiopathic ventricular tachycardia from the right ventricular outflow tract by a 12-lead ECG: A study of pace mapping using multielectrode "basket" catheter. Pacing Clin Elecrophysiol 2006 22 : 1760 1768.
30. Sekiguchi Y, Aonuma K, Takahashi A, et al. Electrocardiographic and electrophysiologic characteristics of ventricular tachycardia originating within the pulmonary artery. J Am Coll Cardiol 2005 45 : 887 895. (Pubitemid 40342815)
31. Kamakura S, Shimizu W, Matsuo K, et al. Localization of optimal ablation site of idiopathic ventricular tachycardia from right and left ventricular outflow tract by body surface ECG. Circulation 1998 98 : 1525 1533. (Pubitemid 28481669)
32. Babai BMA, Aslani A, Shahrzad S. aVR sign as a risk factor for life-threatening arrhythmic events in patients with Brugada Syndrome. Heart Rhythm 2007 4 : 1009 1012. (Pubitemid 47163742)
33. Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med 1995 26 : 195 201.
34. Groleau G, Jotte R, Barish R. The electrocardiographic manifestations of cyclic antidepressant therapy and overdose: A review. J Emerg Med 1990 8 : 597 605. (Pubitemid 20327455)
35. Gutgesell H, Atkins D, Barst R, et al. Cardiovascular monitoring of children and adolescents receiving psychotropic drugs a statement for healthcare professionals From the Committee on Congenital Cardiac Defects, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation 1999 99 : 979 982. (Pubitemid 29094318)
36. Singh N, Singh HK, Harinder K, et al. Serial electrocardiographic changes as a predictor of cardiovascular toxicity in acute tricyclic antidepressant overdose. Am J Ther 2002 9 : 75 79.
37. Warner RA, Hill NE, Mookherjee S, et al. Improved electrocardiographic criteria for the diagnosis of the left anterior hemiblock. Am J Cardiol 1983 51 : 723 726. (Pubitemid 13141958)
38. Warner RA, Hill NE, Mookheree S, et al. Electrocardiographic criteria for the diagnosis of combined inferior myocardial infarction and left anterior fascicular hemiblock. Am J Cardiol 1983 51 : 718 722. (Pubitemid 13141957)
39. Mittal SR, Jain S. Electrocardiographic diagnosis of right ventricular infarction in the presence of left ventricular posterior infarction. Int J Cardiol 1999 68 : 125 128. (Pubitemid 29083375)
40. Edhouse J, Thakur RK, Khalil J. ABC of clinical electrocardiography: Conditions affecting the left side of the heart. BMJ 2002 324 : 1264 1267. (Pubitemid 34553569)
41. Jauhar R, Gianos E, Baqai K, et al. Primary angioplasty in a patient with dextrocardia. J Interv Cardiol 2005 18 : 127 130. (Pubitemid 40676863)
42. Al-Khadra AS. Images in cardiovascular medicine. Mirror-image dextrocardia with situs inversus. Circulation 1995 91 : 1602 1603.
43. Bhakta D, Breall JA, Kalaria VG. Complete sinus inversus and bicuspid aortic valve stenosis. J Invasive Cardiol 2003 15 : 213 215. (Pubitemid 36438319)
44. Spodick DH. Diagnostic electrocardiographic sequences in acute pericarditis: Significance of PR segment and PR vector changes. Circulation 1973 48 : 575 580.
45. McGinn S, White PD. Acute cor pulmonale resulting from pulmonary embolism. JAMA 1935 104 : 1473 1480.
46. Petruzelli S, Palla A, Pieraccini F, et al. Routine electrocardiography in screening for pulmonary embolism. Respiration 1986 50 : 233 243. (Pubitemid 17220496)
47. Livaditis IG, Paraschos M, Dimopoulos K. Massive pulmonary embolism with ST elevation in leads V1-V3 and successful thrombolysis with tenecteplase. Heart 2004 90 : e41.
48. Strizik B, Forman R. New ECG changes associated with tension pneumothorax. A case report. Chest 1999 115 : 1742 1744. (Pubitemid 29275673)
49. Rostoff P, Latacz P, Piwowarska W, et al. Transient ST-segment elevation in lead aVR associated with tako-tsubo cardiomyopathy. Int J Cardiol 2009 134 : e97 e100.
50. Case RB, Tansey WA, Mogtader AH. A sequential angular lead presentation. J Electrocardiol 1979 12 : 395 401.
51. Sgarbossa EB, Barold SS, Pinski SL, et al. Twelve-lead electrocardiogram: The advantages of an orderly frontal lead display including lead -aVR. J Electrocardiol 2004 37 : 141 147.