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Comment & Response
March 2018

Beware of Limb Lead Reversal—Reply

Author Affiliations
  • 1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
JAMA Intern Med. 2018;178(3):435. doi:10.1001/jamainternmed.2017.8639

In Reply We very much appreciate Dr Littmann’s close inspection and review of our Teachable Moment.1 Although we do acknowledge that the right arm and right leg electrodes may have been reversed in Figure 2A, this does not detract from the main point of the article: the importance of evaluating the onset and termination of tachycardias in identifying their mechanism. Furthermore, such a reversal should not have affected the P wave vector in leads III and aVF, where we believe that the initial vector is indeed negative. It is also positive in lead aVL, consistent with the diagnosis of AV nodal reentrant tachycardia. In addition, a similar P wave morphology was seen on a number of other electrocardiograms performed during the patient’s hospitalization.

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