Index
Ep Defined | Getting Started | Working in the EP Lab
Right Atrium | Right Ventricle | Left Atrium | Left Ventricule | Cardiac Conduction | Cardiac Cell Properties | Action Potential | Sympathetic or Not | Med Page
Electrograms Defined | Recording Modes | Electrode Spacing | Filters | EGM Interpretation | Arrhythmia Analysis
The Physical Lab | Tools of the Trade
Setting Up | Catheter Placement | Baseline Measurement | SNRT | Conduction Study | Arrhythmia Induction | Pacing Protocols | Ablation | Tilt Table | Secrets to Success
Bradycardia | Atrial Tach | Atrial Flutter | Atrial Fibrillation | AVNRT | AVRT | Ventricular Tachycardia
Surface ECG's | Intracardiac Questions | Med Challenge | Advanced

Electrograms - Surface ECG's

This section is under development.
100 Years of Experience....

The following items were sourced from Rapid Interpretation of ECG's by Dale Dubin.
In 1790, Luigi Galvani proved that electrical current would stimulate muscle tissue.
In 1855, Kolicker and Mueller tied electrical stimulation of the muscle to the heart beat

Surace ECG background & history
Unipolar and Bipolar
Einthoven
How ro read
Timing Grid

Timing Intervals on the Surface ECG

Discussion of grid and measuring timing and intervals.

Unipolar and Bipolar

Surface Electrocardiograms
Three Bipolar Leads – I, II and III (Lead II = Lead I + Lead III)
Lead I, -pole = right shoulder, +pole = left shoulder – used to show right to left or left to right activation.
Lead II, -pole=right shoulder, +pole = left leg – used to show high to low or low to high activation.
Lead III, -pole=left shoulder, +pole = left leg – used to show high to low or low to high activation.
Three Augmented Unipolar Leads – aVR (always negative), aVL, aVF
aVR, -pole=Wilson’s Central Terminal, +pole = Right Shoulder
aVL, -pole=Wilson’s Central Terminal, +pole = Left Shoulder
aVF, -pole=Wilson’s Central Terminal, +pole = foot
Six Unipolar Chest Leads – V1-V6 (Horizontal Plane) 1
V1, -pole=Wilson’s Central Terminal, +pole = 4th intercostal space just right of mid sternum
V2, -pole=Wilson’s Central Terminal, +pole = 4th intercostal space just left of mid sternum
V3, -pole=Wilson’s Central Terminal, +pole = mid distance between V2 and V4.
V4, -pole=Wilson’s Central Terminal, +pole = 5th intercostal space at left midclavicular(mid collar bone) line.
V5, -pole=Wilson’s Central Terminal, +pole = 5th intercostal space left anterior axillary (armpit) line
V6, -pole=Wilson’s Central Terminal, +pole = 5th intercostal space left midaxillary line

Lead Visualization
II, III and aVF = Inferior aspect, High to Low / Low to High Activation
I, aVL = Left Lateral, Right to Left / Left to Right Activation
I, aVL, V5 and V6 = Lateral, Anterolateral aspect.
V1 and V2 = Anteroseptal LV wall – Mirror Image of posterior wall
V3 and V4 = Anterior LV Wall
V5 and V6 Anteroseptal, anterior and anterolateral walls
P waves
QRS
T/U waves
Calculating Rate
Putting it all together (Look at Normal)
Axis Deviation
Premature Depolarizations (difference between beats and depolarizations)
Conduction defects / Blocks and Hemiblocks
AV Conduction Delay – 1st degree block
Intermittent AV Conduction Delay to Block – 2nd degree block – Type I
Intermittent AV Conduction Block – 2nd degree block Type II
Complete AV Block
Bundle Branch Blocks
Right Bundle Branch Block
Left Hemi-Block
Left Anterior Hemiblock
Left Posterior Hemiblock
Left Bundle Branch Block
Bifasicular Block

Effect of Skin Electrode Location on Radiofrequency Ablation Lesions Mudit K. Jain, B.E., Gery Tomassoni, M.D., Richard E. Riley, M.S., and Patrick D. Wolf, Ph.D.
Journal of Cardiovascular Electrophysiology Vol 9, No 12, December 1998           If you have ever heard experienced EP staff discussing placement of the RF skin electrode, you are probably hearing them discuss, in part, some of the information contained in this article. This is a must read for all EP staff.

Source 1 The following items were sourced from Rapid Interpretation of ECG's by Dale Dubin.

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