AVR the neglected lead

The augmented limb leads (AVR, AVL and AVF) were developed to derive more localized information than the bipolar leads I, II and III could offer. The purpose of lead AVR was to obtain specific information from the right upper side of the heart, such as the outflow tract of the right ventricle and the basal part of the interventricle septum. However, most electrocardiographers consider lead AVR as giving reciprocal information from the left lateral side, being already covered by the leads AVL, II, V5 and V6. This has been the reason that lead AVR has become largely neglected.

Lead AVR can be very useful in identifying left main coronary artery (LMCA) obstruction. Ischemia of the basal part of the interventricular septum is the electrocardiographic explanation for the occurrence of ST-segment elevation (STE) in AVR.