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aVR - some references

This page is a quick reference page we created following a conversation with some paramedics who were discussing the use of the aVR lead in a 12 lead ECG.  The studies below describe how useful it is to understand aVR, and what it can help show us.

 

Barrabés, J. A., Figueras, J., Moure, C., Cortadellas, J., & Soler-Soler, J. (2003). Prognostic value of lead aVR in patients with a first non-ST-segment elevation acute myocardial infarction. Circulation, 108(7), 814–819. https://doi.org/10.1161/01.CIR.0000084553.92734.83

Mebust, D. (2015). Image Diagnosis: aVR, the Forgotten Lead. The Permanente Journal, 19(1), 101–102. https://doi.org/10.7812/TPP/14-099

Morris, N., & Body, R. (2016). BET 2: Is ST elevation in aVR a sure sign of left main coronary artery stenosis?: Table 2. Emergency Medicine Journal, 33(1), 77–80. https://doi.org/10.1136/emermed-2015-205558.2

George, A., Arumugham, P. S., & Figueredo, V. M. (2010). aVR - The forgotten lead. Experimental and Clinical Cardiology, 15(2).

Omar, H. R., & Camporesi, E. M. (2014). The importance of lead aVR interpretation by emergency medicine physicians. The American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2014.07.018

Zhong-qun, Z., & Nikus, K. C. (2010). Factors influencing and significance of ST-segment deviation in lead aVR in acute inferior wall ST-elevation myocardial infarction. Journal of Electrocardiology, 43(4), 288–293. https://doi.org/10.1016/j.jelectrocard.2010.02.010

Ducas, R., Ariyarajah, V., Philipp, R., Ducas, J., Elliott, J., Jassal, D., … Hussain, F. (2013). The presence of ST-elevation in lead aVR predicts significant left main coronary artery stenosis in cardiogenic shock resulting from myocardial infarction: the Manitoba cardiogenic shock registry. International Journal of Cardiology, 166(2), 465–468. https://doi.org/10.1016/j.ijcard.2011.11.003

Habibzadeh, M. R., & Ewy, G. A. (2007). ST-Segment Elevation in Lead aVR Greater Than that in Lead V 1 , Secondary to Diffuse Myocardial Ischemia from Prolonged Hypotension, 254, 251–254. https://doi.org/10.1002/clc

Ho, Y.-L., Lin, L.-Y., Lin, J.-L., Chen, M.-F., Chen, W.-J., & Lee, Y.-T. (2003). Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia. The American Journal of Cardiology, 92(12), 1424–1428. https://doi.org/10.1016/j.amjcard.2003.08.051

Vorobiof, G., & Ellestad, M. H. (2011). Lead aVR: dead or simply forgotten? JACC. Cardiovascular Imaging, 4(2), 187–190. https://doi.org/10.1016/j.jcmg.2010.11.011

GREATER ST-SEGMENT ELEVATION IN LEAD AVR IS ASSOCIATED WITH WORSE OUTCOMES IN PATIENTS WITH NON-ST-SEGMENT ELEVATION ACUTE CORONARY SYNDROME. (2011).

Barrabés, J. a, & Figueras, J. (2008). Does lead aVR contain prognostic information in patients with non-ST-elevation acute coronary syndromes? American Heart Journal, 155(2), e11; author reply e13. https://doi.org/10.1016/j.ahj.2007.10.033

Barrabés, J. A., & Figueras, J. (2008). Does lead aVR contain prognostic information in patients with non-ST-elevation acute coronary syndromes? American Heart Journal, 155(2), e11; author reply e13. https://doi.org/10.1016/j.ahj.2007.10.033

Rostoff, P., Latacz, P., Piwowarska, W., Konduracka, E., Bolech, A., & Zmudka, K. (2009). Transient ST-segment elevation in lead aVR associated with tako-tsubo cardiomyopathy. International Journal of Cardiology, 134(3), e97–e100. https://doi.org/10.1016/j.ijcard.2008.01.003

Gul, E. E., & Nikus, K. C. (2011). An unusual presentation of left anterior descending artery occlusion: significance of lead aVR and T-wave direction. Journal of Electrocardiology, 44(1), 27–30. https://doi.org/10.1016/j.jelectrocard.2010.08.009

Yan, A. T., Yan, R. T., Kennelly, B. M., Anderson, F. a, Budaj, A., López-Sendón, J., … Goodman, S. G. (2007). Relationship of ST elevation in lead aVR with angiographic findings and outcome in non-ST elevation acute coronary syndromes. American Heart Journal, 154(1), 71–78. https://doi.org/10.1016/j.ahj.2007.03.037

Szymański, F. M., Grabowski, M., Filipiak, K. J., Karpiński, G., & Opolski, G. (2008). Admission ST-segment elevation in lead aVR as the factor improving complex risk stratification in acute coronary syndromes. The American Journal of Emergency Medicine, 26(4), 408–412. https://doi.org/10.1016/j.ajem.2007.06.015

Kotoku, M., Tamura, A., Abe, Y., & Kadota, J. (2009). Determinants of ST-segment level in lead aVR in anterior wall acute myocardial infarction with ST-segment elevation. Journal of Electrocardiology, 42(2), 112–117. https://doi.org/10.1016/j.jelectrocard.2008.10.006

Kanei, Y., Sharma, J., Diwan, R., Sklash, R., Vales, L. L., Fox, J. T., & Schweitzer, P. (2010). ST-segment depression in aVR as a predictor of culprit artery and infarct size in acute inferior wall ST-segment elevation myocardial infarction. Journal of Electrocardiology, 43(2), 132–135. https://doi.org/10.1016/j.jelectrocard.2009.09.003

Tomcsányi, J., Bózsik, B., Sármáns, B., & Zsoldos, A. (2009). Dangerous single lead ST elevation. Journal of Electrocardiology, 42(2), 111.e1-2. https://doi.org/10.1016/j.jelectrocard.2008.10.001

Gorgels, a P., Engelen, D. J., & Wellens, H. J. (2001). Lead aVR, a mostly ignored but very valuable lead in clinical electrocardiography. Journal of the American College of Cardiology, 38(5), 1355–1356. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11691507

Kühl, J. T., & Berg, R. M. G. (2009). Utility of lead aVR for identifying the culprit lesion in acute myocardial infarction. Annals of Noninvasive Electrocardiology : The Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 14(3), 219–225. https://doi.org/10.1111/j.1542-474X.2009.00300.x

Kireyev, D., Arkhipov, M. V, Zador, S. T., Paris, J. A., & Boden, W. E. (2010). Clinical Utility of aVR — The Neglected Electrocardiographic Lead DIAGNOSIS OF ACUTE CORONARY, 175–180.

Lin, Y.-Y., Hsu, C.-W., Chu, S.-J., & Tsai, S.-H. (2008). Additional causes of electrocardiographic changes in lead aVR. The American Journal of Emergency Medicine, 26(2), 242–243. https://doi.org/10.1016/j.ajem.2007.05.004

Williamson, K., Mattu, A., Plautz, C. U., Binder, A., & Brady, W. J. (2006). Electrocardiographic applications of lead aVR. The American Journal of Emergency Medicine, 24(7), 864–874. https://doi.org/10.1016/j.ajem.2006.05.013

Rostoff, P., & Piwowarska, W. (2006). ST segment elevation in lead aVR and coronary artery lesions in patients with acute coronary syndrome. Kardiologia Polska, 64(1), 8–14; discussion 15. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16444621

Kossaify, A. (2013). ST Segment Elevation in aVR: Clinical Significance in Acute Coronary Syndrome. Clinical Medicine Insights. Case Reports, 6, 41–45. https://doi.org/10.4137/CCRep.S11261

Kühl, J. T., & Berg, R. M. G. (2009). Utility of lead aVR for identifying the culprit lesion in acute myocardial infarction. Annals of Noninvasive Electrocardiology : The Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 14(3), 219–225. https://doi.org/10.1111/j.1542-474X.2009.00300.x

Aygul, N., Ozdemir, K., Tokac, M., Aygul, M. U., Duzenli, M. A., Abaci, A., … Bodur, S. (n.d.). Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and in-hospital outcome in ST-elevation myocardial infarction: an electrocardiographic predictor of poor prognosis. Journal of Electrocardiology, 41(4), 335–341. https://doi.org/10.1016/j.jelectrocard.2008.02.025

Zhong-qun, Z., Wei, W., Chong-quan, W., Shu-yi, D., Chao-rong, H., & Jun-feng, W. (n.d.). Acute anterior wall myocardial infarction entailing ST-segment elevation in lead V3R, V1 or aVR: electrocardiographic and angiographic correlations. Journal of Electrocardiology, 41(4), 329–334. https://doi.org/10.1016/j.jelectrocard.2007.12.004

Chenniappan, M., Sankar, R. U., Saravanan, K., & Karthikeyan. (2013). Lead aVR--the neglected lead. The Journal of the Association of Physicians of India, 61(9), 650–654. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24772703

 

Vereckei, A., Duray, G., Szénási, G., Altemose, G. T., & Miller, J. M. (2008). New algorithm using only lead aVR for differential diagnosis of wide QRS complex tachycardia. Heart Rhythm : The Official Journal of the Heart Rhythm Society, 5(1), 89–98. https://doi.org/10.1016/j.hrthm.2007.09.020

Kireyev, D., Arkhipov, M. V, Zador, S. T., Paris, J. A., & Boden, W. E. (2010). Clinical utility of aVR-The neglected electrocardiographic lead. Annals of Noninvasive Electrocardiology : The Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc, 15(2), 175–180. https://doi.org/10.1111/j.1542-474X.2010.00359.x

Aygul, N., Ozdemir, K., Tokac, M., & Aygul, U. (2008). Value of lead aVR in predicting acute occlusion of proximal left anterior descending coronary artery and in-hospital outcome in ST-elevation myocardial infarction : an electrocardiographic predictor of poor prognosis, 41, 335–341. https://doi.org/10.1016/j.jelectrocard.2008.02.025