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:
Research consistently shows that leads V1 and V6 (or their bipolar equivalents MCL1 and MCL6) are the best leads for differentiating wide QRS rhythms.1–,6 The QRS morphologies displayed in these leads are invaluable in differentiating ventricular tachycardia from supraventricular tachycardia with aberrant conduction. Other criteria used in the differential diagnosis, such as the presence of AV dissociation, QRS width, QRS axis, and the presence of fusion or capture beats, can be observed in other leads as well. Multiple-lead monitoring is better than single-lead monitoring, and a 12-lead ECG should be done during the arrhythmia whenever possible.