Evaluation of Electrocardiographic Leads for Detection of Atrial Activity (P Wave) in Ambulatory EGG Monitoring: A Pilot Study

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Abstract
The usual lead systems for ambulatory ECG monitoring (AECG) used in the evaluation of arrhythmias is a modified bipolar V‐1 and V‐5. A comparison of various lead systems to enhance the detection of atrial activity (p waves) has not been reported. We evaluated various surface lead systems in 12 subjects comparing p waves recorded at 20 mm/mV and 50 mm/sec. We compared p wave area, amplitude, and duration from modified bipolar V1 and V5 as well as seven nonstandard leads recorded on a AECG monitor. Of the seven nonstandard leads, a vertical sternal lead, with the negative pole just below the suprasfernal notch and the positive pole at the xiphoid process, had the largest area (1.46 ± 0.65 mm2), and also had a greater area than the standard V, (0.88 ± 0.45 mm) and V5, (1.06 ± 0.49 mm2) lead system (P < 0.01). We conclude that the bipolar vertical sternal lead system provides a larger p wave area than seven nonsfandard bipolar lead systems and the two standard lead systems currently used in AECG monitoring. Replacement of the modified bipolar V1 lead with a vertical sternal lead should improve the recognition of atrial activity and, therefore, enhance the diagnosis of cardiac arrhythmias.