On the Use of the Inverse Electrocardiogram Leads

This viewpoint expresses reservations about using the inverse (or negative) aVR lead in the so-called Cabrera limb lead sequence and the implementation of inverse representations of any of the other 12 standard electrocardiographic leads. Instead, the author proposes that in patients with suspected acute coronary syndromes and a nondiagnostic electrocardiographic results, electrocardiography be repeated (“double electrocardiography”), with the V1 to V6 electrodes used to record leads V3R, V4R, V7 to V9 to the left of the spine, and V9R to the right of the spine to aid in triaging patients to the appropriate management.