Determination of electrical axis is especially useful for the diagnosis of the following:

  Left anterior fascicular block (left anterior hemiblock).

  Left posterior fascicular block (left posterior hemiblock).

  Ventricular tachycardia (VT) (the deviation of electrical axis by at least 40 degrees to left or to right during wide QRS tachycardia supports the diagnosis of VT).

  Right ventricular hypertrophy.

Left axis deviation is observed in

  normal variants.

  left ventricular hypertrophy

  left anterior fascicular block

  left bundle branch block

  some types of ventricular tachycardias

  some congenital heart diseases (tricuspid atresia, endocardial cushion defect).

Right axis deviation is observed in

  normal variants (may be normal in infants)

  right ventricular hypertrophy

  left posterior fascicular block

  lateral myocardial infarction

  emphysema (the heart assumes a more vertical position when anteroposterior chest diameter increases)


  acute pulmonary embolism


Extreme right axis deviation (indeterminate axis, northwest region, no man's land)

  is between -90 and 180 degrees.

QRS complexes are negative in leads I and aVF.

  Infants with Ostium Primum type atrial septal defect (ASD) or Atrioventricular (AV) canal defect may show extreme right axis deviation.