La derivazione di Lewis per l’interpretazione elettrocardiografica delle tachicardie ritmiche a complessi larghi

19 Dic

Molti criteri ellettrocardiografici e clinici sono stati individuati nel corso degli anni per distinguere tra aberranza ed ectopia in corso di tachicardie ritmiche a complessi larghi, ma nessuno di essi ha mai raggiunto livelli di specificità e sensibilità tali da permettere di fare diagnosi.

La derivazione di Lewis ( Lewis T. Auricular fibrillation. In: Clinical Electrocardiography. 5th ed.London, UK: Shaw and Sons; 1931:87–100) amplificando l’attività atriale se presente, permette di stabilirne il rapporto con il QRS e di fare diagnosi certa sull’origine della tachiaritmia.

La presenza di dissociazine atrioventricolare individua con certezza l’origine ventricolare (ectopia) dell’aritmia.

Per registrare la derivazione di Lewis basta posizionare le derivazioni degli arti come indicato dalla figura derivata dal lavoro originale di Lewis, portare la velocità di scorrimento della carta a 50 mm/s e la calibrazione a 1mV=20 mm per permettere di individuare anche un’attività atriale di basso voltaggio in corso aritmie ad alta frequenza.

Lewis lead

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