ECG monitoring leads and special leads

ECG monitoring is common place in the hospital and even pre-hospital setting. The need for different types of lead systems in different settings has been emphasised. Simple three electrode bipolar recording is ubiquitous for monitoring. This can be used to record modified bipolar chest leads as well. Using five leads gives the option of getting a chest lead in addition to bipolar limb leads, enhancing detection of ischemia during procedures. Lead stability is important when the movement of the subject is maximum as in exercise testing. Mason-Likar modification with limb leads shifted to the torso is popular for exercise testing, though the diagnostic value of the ECG is altered. Lund system with leads on proximal part of limbs have both stability and fair diagnostic value. EASI lead system permits derivation of 12 leads from just five electrodes. Lewis lead and the newly devised modified limb lead system are useful in enhancing detection of atrial activity. Fontaine lead has been designed to improve visualization of Epsilon wave in arrhythmogenic right ventricular dysplasia.