Left atrial enlargement electrocardiogram

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Left atrial enlargement electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]

Overview

Left atrial enlargement may be observed among patients with pressure or volume overload of the left atrium.

Differential Diagnosis of Left Atrial Enlargement

EKG in Left Atrial Enlargement

Left atrial enlargement produces a broad, bifid P wave in lead II (P mitrale) and enhances the terminal negative portion (negative deflection) of the P wave in V1.

In lead I and/or II the following may be seen:

  • Bifid P wave with > 40 ms between the two peaks
  • Total P wave duration > 110 ms

In lead V1, the following may be seen:

  • Biphasic P wave with terminal negative portion > 40 ms duration (>0.04 sec or 1 small square)
  • Biphasic P wave with terminal negative portion > 1mm deep

Left atrial enlargement as seen in lead V1

Examples of Left Atrial Enlargement on EKG

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