An interesting electrocardiogram caused by lead reversal

Changjun Li; Nan Wang; Qinghua Chang; Dianzhu Pan

doi:10.1186/s12872-024-03875-2

An interesting electrocardiogram caused by lead reversal

BMC Cardiovasc Disord. 2024 Apr 20;24(1):217. doi: 10.1186/s12872-024-03875-2.

Authors

Changjun Li¹, Nan Wang², Qinghua Chang², Dianzhu Pan³

Affiliations

¹ Department of Gerontology, The First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China.
² Department of Cardiology, The First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China.
³ Department of Respiratory, The First Affiliated Hospital of Jinzhou Medical University, Renmin Street, Jinzhou, 121000, Liaoning Province, China. pandianzhu@163.com.

Abstract

Background: During normal sinus rhythm, atrial depolarization is conducted from right atrium to left atrium through Bachmann's bundle, and a normal P wave axis which is measured on the frontal plane is between 0º and + 75º. The change of P wave polarity is helpful for the analysis of origin point.

Case presentation: We report a patient with negative P wave in lead I. The characteristics of QRS complex in leads V₁ to V₆ are helpful to preliminarily differential diagnosis. The 12-lead electrocardiogram (ECG) with correct limb leads (right arm-left arm) placement shows sinus rhythm with complete right bundle branch block (RBBB).

Conclusions: The change of P wave polarity as well as characteristics of QRS complex can help identify limb-lead reversals.

Keywords: Acquired dextrocardia; Electrocardiogram; Left atrial rhythm; Limb-lead reversals; Mirror-image dextrocardia.

Publication types

Case Reports

MeSH terms

Atrioventricular Node
Bundle-Branch Block* / diagnosis
Electrocardiography*
Heart Atria
Humans
Sinoatrial Node