The electrical axis for the QRS complex in the horizontal plane can be determined by examining the precordial leads (V1 through V6). Change in the electrical axis in the horizontal plane is referred to as axis rotation.
Normally V3 or V4 is isoelectric, with V1 and V2 negative and V5 and V6 positive. The isoelectric lead may be referred to as the transitional lead.
With leftward rotation in the horizontal plane, the isoelectric point may be seen in V5 or V6, with V3 and V4 predominantly negative.
With rightward rotation in the horizontal plane, the isoelectric point may be seen in V1 or V2, with V3 and V4 predominantly positive.
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