Clinical Electrophysiology -> Ventricular Arrhythmias -> Electrocardiography D-PO05 - Poster Session V (ID 39) Poster

D-PO05-236 - Enhanced P Wave Recognition In Wide Qrs Complex Tachycardia By Modified Lewis Lead (ID 603)

 J. Wen: Nothing relevant to disclose.


Background: Atrioventricular dissociation is one of the most specific criteria for ventricular tachycardia diagnosis, however it can only be identified by standard ECG in 30% of such cases. Lewis lead is a feasible way to amplify the P wave amplitude in atrial fibrillation, which was also reported in a few cases of wide QRS complex tachycardia (WCT) differential diagnosis.
Objective: In this research, we aim to increase the P wave recognition during WCT by a modified Lewis lead approach.
Methods: The modified Lewis lead is set as moving the right arm electrode to the sternal manubrium and left arm electrode to the right fourth intercostal space, the other leads are consistent with the standard leads. The P wave amplitude was compared between the modified Lewis lead ECG and standard ECG in 78 normal sinus rhythm (NSR). WCT were simulated by RV and LV pacing with different circle length (CL) in 68 patients of the left side AV accessory pathway after successfully ablated by trans-septal approach. Both standard 12 lead ECG and modified Lewis lead ECG (25mm/s, 10 mV) were taken and the P wave recognition were analyzed separately.
Results: Modified Lewis lead can increase the P wave amplitude by 50.6%±23.1% in 78 NSR. The P wave recognition by modified Lewis lead ECG is higher than those achieved by standard ECG (67± 18.9% vs 31.2±10.1% in rapid RV pacing, and 69.5± 16.7% vs 33.2±8.7% in rapid LV pacing). The P wave recognition of different RV or LV pacing CL were higher in each modified Lewis lead ECG group. (figure)
Conclusion: Recording of modified Lewis lead ECG is feasible to increase the P wave recognition in WCT, which is a simple way to improve the accuracy of differential diagnosis in WCT.