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(Circulation. 2001;103:e90.)
© 2001 American Heart Association, Inc.

Correspondence

"Switched" Precordial Leads

Jacob Zatuchni, MD

University of Pennsylvania School of Medicine, Pennsylvania Cardiology Associates, Pennsylvania Hospital, Philadelphia, Pennsylvania

Paul P. Elko

Global Product Manager, Electrocardiographs and Analysis Algorithms, G. E. Marquette Medical Systems, Philadelphia, Pennsylvania

To the Editor:

In the article on "switched" precordial leads by Hurst,¹ an ECG is shown in which leads V₁ and V₃ have been switched. Hurst states that the V₁ lead wire was erroneously plugged into the V₃ receptacle, and the lead wire labeled V₃ was erroneously plugged into the V₁ receptacle.

It is important to note, however, that a V lead in Wilson terminology is a V lead, regardless of where the exploring electrode is placed [V lead=exploring electrode on chest minus central terminal (R+L+F)/3], where R indicates right arm, L indicates left arm, and F indicates left leg. Only the subscript (1, 2, 3, 4, 5, or 6) specifies its location.

Therefore, if lead V₃ is placed at the V₁ position, the ECG should be that of V₁. Obviously, it is not, and Hurst did not address this. The reason why it isn’t resides in the design and circuitry of the apparatus. Regardless of the label on the lead wire electrode, the data printed are always labeled according to the channel coming into the acquisition module. For example, if the electrode wire labeled V₆ is plugged into the V₁ socket, the data will be printed out as lead V₁ but with complexes of lead V₆.

Therefore, Hurst’s admonition that today’s equipment requires that leads be placed specifically as labeled should be emphasized, because the socket labeled V₃ will always be the same in any of the usual chest locations, rather than indicative of the p potential underneath the exploring electrode.

References

1. Hurst JW. "Switched" precordial leads. Circulation. 2000;101:2870–2871.[Free Full Text]
   

Response

J. Willis Hurst, MD

Division of Cardiology, Emory University School of Medicine, 1462 Clifton Road, NE, Suite 301, Atlanta, GA 30322 \.

I agree with Zatuchni and Elko’s comments and appreciate their contribution to the solution of the problem.

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