Isoelectric Lead 1
Report:
Sinus rhythm
Third degree AV block
Pacemaker rhythm
Reversed arms/legs leads!
Comment:
Flat Lead 1 is virtually pathognomonic of legs/arms reversal. The P waves also assume retrograde polarity (one is seen in the last cycle in leads 1, 2, 3).
Repeat trace with correct lead placement is shown below (Fig 195a). Lead V1 looks more normal too, presumably due to more proper reapplication of all the electrodes.
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