Complete Chest Lead Reversal
Report:
Atrial pacemaker rhythm 78/min
Complete chest lead reversal
Possible left ventricular hypertrophy
Comment:
This is a rare variant of lead reversal. It happens when the entire block of V-lead terminals is rotated 180o and inserted into the machine terminal. In many newer models this is impossible as the leads come straight out of the machine and cannot be detached. The corrected placement is shown below.
Interestingly, the computer diagnosed both RVH and lateral MI on the precordial pattern. Some cases of congenital heart disease may indeed have this ECG pattern (not a true MI, however) but invariably show Q waves in the frontal leads as well. A posterolateral MI should have been programmed here.
Those who missed right atrial pacing may be forgiven – the only lead showing tiny pacing spikes is aVL. The patient had a DDD pacemaker with long AV interval allowing native, narrow QRSs to follow atrial pacing.
LVH is the reason for RV6 > RV5 in this trace.
Another ECG was recorded subsequently (Fig 5a).
If you have any suggestions for or feedback on this report, please let us know.
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