Q What is the best lead to use for continuous bedside monitoring to detect arrhythmia?

The choice of monitoring lead should be based on the patient’s clinical situation and dictated by the arrhythmias most likely to occur and be clinically significant for that patient:

  • Premature atrial complexes, abnormal sinus rhythms, and most heart blocks, can be recognized in any lead that displays clear P waves and QRS complexes.

  • Atrial fibrillation can be recognized in most leads by the irregular R-R intervals and chaotic atrial activity that characterize this rhythm.

  • When the QRS becomes wide, as it does in bundle branch block, ventricular rhythms, and antegrade conduction over an accessory pathway, it is very important to choose a lead that best displays the electrocardiographic criteria used to differentiate wide QRS rhythms.

Research consistently shows that leads V1 and V...

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