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The hexaxial reference system is a diagram that is used to determine the heart's electrical axis in the frontal plane.
Cabrera circle (captions in German)
Diagram showing how the polarity of the QRS complex in leads I, II, and III can be used to estimate the heart's electrical axis in the frontal plane.

The hexaxial reference system is diagram based on the first six leads of the 12 lead ECG. It is used to help determine the heart's electrical axis in the frontal plane.[1]

To use the hexaxial reference system, locate the most isoelectric (or equiphasic) lead (I, II, III, aVR, aVL, or aVF) on a diagnostic quality ECG with proper lead placement. Then find the corresponding spoke on the hexaxial reference system. The perpendicular spoke will point to the heart's electrical axis. To determine which numerical value should be used, observe the polarity of the perpendicular lead on the ECG.

For example, if the most isoelectric (or equiphasic) lead is aVL, the perpendicular lead on the hexaxial reference system is lead II. If lead II is positively deflected on the ECG, the heart's electrical axis in the frontal plane will be approximately +60o.

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