Lewis lead

Description

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.

Useful in:

• 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

Associated Persons

• Sir Thomas Lewis (1881-1945)

Alternative names

• S5-lead placement

References

• 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