A modified Lewis ECG lead system for ambulatory monitoring of atrial arrhythmias

- We proposed a modified Lewis ECG lead for atrial activity enhancement.
- The modified Lewis lead was compared to other atrial activity enhancing leads.
- The modified lead has twice as large atrial amplitude as the original Lewis leads.
- The modified lead offers the best atrial-to-myographic activity ratio.

BackgroundWhen using a reduced ECG lead system with three leads or less, the analysis of atrial activity during arrhythmias can become problematic due to low signal amplitude and noise. Long ago, Sir Thomas Lewis proposed a lead system for atrial activity enhancement in which two electrodes are placed directly on the chest, however, these leads are sensitive to arm movement artifacts. In this study, a modified Lewis lead system is proposed that is better suited for ambulatory applications since the electrodes are placed in areas with less muscle.Materials and methodsThe proposed modification is compared to the original Lewis leads as well as to the ES lead of the EASI system. Forty-one healthy volunteers and 10 patients with atrial fibrillation participated.ResultsThe modified Lewis lead has nearly 3 times as large atrial amplitude as the original Lewis leads, and is associated with the largest amplitude of atrial activity when compared to the amplitude of electromyographic activity in healthy volunteers.ConclusionThe results suggest that the proposed modification of the Lewis lead system has potential to improve ambulatory monitoring of atrial arrhythmias.