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The relationships of lead 1, chest leads from the C3, C4, and C5 positions, and certain leads made from each shoulder region: The bearing of these observations upon the Einthoven equilateral triangle hypothesis and upon the formation of lead 1

The relationships of lead 1, chest leads from the C3, C4, and C5 positions, and certain leads made from each shoulder region: The bearing of these observations upon the Einthoven equilateral triangle hypothesis and upon the formation of lead 1

Amer Heart Jour 21(2): 215-227

The ventricular complexes of Lead 1 and of chest leads from the C5 position resemble one another, both when normal and abnormal, except that those of lead 1 are usually the smaller. Lead.CR5 shows a closer correlation with Lead 1 than does Lead CF5. There is no correlation between Lead 1 and chest leads from the C3 position. Abnormalities in the contour of tracings made from the C4 position tend to have a counterpart in Lead 1 only when they are also recordable from the C5 position. When electrocardiograms are taken from each shoulder region, with the electrodes paired across the root of the arm, the ventricular deflections from the right side are, as a rule, very small, whereas those from the left are of much greater amplitude, with a few exceptions. Ventricular complexes in leads taken on the left side of the body from . the suprasternal notch to the arm and to the C5 position, and from the top of the shoulder to the axilla (across the root of the arm) show a remarkable correlation with each other, with Lead 1, and with CR5. Leads taken from comparable positions on the right side show no analogous correlations. When the relative size of the auricular complexes from the 2 shoulder regions is compared with that of the ventricular complexes, a definite difference is noted. The auricular complexes, instead of being larger on the left, are, on the avg., of approx. equal size. Changes in potential in the region of the left arm apparently exert a predominating influence in the formation of the ventricular complex of Lead 1, and these potential variations, in turn, are largely dominated by those arising from that portion of the ventricular muscle which governs the contour of the ventricular complex in the C5 position. According to the Einthoven equilateral triangle hypothesis, the extremities are far enough from the heart to permit it to function, in its relation to them, as an electrical point. This may be true of the right arm, for in the majority of cases there is little difference in the potential of adjacent areas in the vicinity of the right shoulder. However, the relatively large differences in the potential or adjacent areas in the vicinity of the left shoulder suggest that the left arm is too close to the heart, electrically, or at least to a portion of the left ventricle, to allow the heart to behave in relation to this extremity according to the Einthoven concept. The left arm must be regarded as a rather inferior chest lead position. The fact that auricular deflections in right shoulder electrocardiograms are proportionately larger than ventricu- lar deflections suggest that, although the ventricles may be far enough from the right arm to function as an electrical point with regard to it, this is not necessarily true of the auricles. These observations do not in any way impair the usefulness of limb lead electrocardiography as an empirical procedure. However, it would seem advisable at least for the present, to regard with a certain amt. of skepticism the time-honored and elaborate, theoretical, electrocardiographic superstructure which has been erected upon Einthoven's assumptions, since there is now reason to doubt the complete validity of the 2 most important ones, namely, that the body acts as a homogeneous fluid conductor, and that the heart functions as an electrical point with regard to each of the 3 extremities.

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