The Lewis lead configuration can help to detect atrial activity and its relationship to ventricular activity. Named after Welsh cardiologist Sir Thomas Lewis (1881-1945) developed and described (1913) his lead configuration to magnify atrial oscillations present during atrial fibrillation.
- Observing flutter waves in atrial flutter
- Detecting P waves in wide complex tachyarrhythmia to identify atrioventricular dissociation
Lewis lead placement
- Right Arm (RA)electrode on manubrium
- Left Arm (LA) electrode over 5th ICS, right sternal border.
- Left Leg (LL) electrode over right lower costal margin.
- Monitor Lead I
- Sir Thomas Lewis (1881-1945)
- S5-lead placement
- Lewis T. Auricular fibrillation. In: Clinical Electrocardiography. 1913: 86-97
- ECG Linrary. ECG Lead positioning
- Bakker AL et al. The Lewis lead: making recognition of P waves easy during wide QRS complex tachycardia. Circulation. 2009 Jun 23;119(24):e592-3
- Huemer M et al. The Lewis Lead for Detection of Ventriculoatrial Conduction Type. Clin. Cardiol. 2016; 39(2): 126–131
- Connelly K. Diagnostics: Alternative EKG Leads Tamig the SRU 2019
Further reading (Dr Smith’s ECG blog)
- Smith S. Regular, steady, and fast at 170 (wide or narrow?), hypoxic, crackles in lungs, B-lines, unconscious. 2019
- Smith S. Hypotensive and Tachycardic in Clinic: A Quick Ticket to the ED and Lewis Leads. 2018
- Smith S. A fast narrow complex rhythm. 2017
- Smith S. Atrial fibrillation with RVR: use POCUS to assess volume; then sinus vs. SVT: use of Lewis leads. 2017
- Smith S. Wide Complex Tachycardia: Lewis Leads Do Not Differentiate VT from SVT with Aberrancy. 2014
- Smith S. A Very Wide Complex Tachycardia. What is the Rhythm? Use Lewis Leads!! 2014
- Smith S. Wide Complex Tachycardia. What is the Diagnosis?. 2012
the names behind the name