Wednesday, January 14, 2009

Back to basics: ECG criteria of atrial enlargement

Righ Atrial Enlargement (RAE):
  • In lead II: Peaked P wave (A-like appearance)
  • Normal P-wave duration
  • Increase in the maximal amplitude of the P wave to >0.20 mV in leads II and aVF, and to >0.10 mV in leads V1 and V2

Left Atrial Enlargement (LAE):
  • In lead II: gives a notch in the P-wave followed by a second hump (M-like appearance)
  • Prolonged P-wave duration(>0.12s) and prollongation of the negative terminal portion of P-wave in lead V1
  • Increase only in the amplitude of the terminal negatively directed portion of the P-wave in lead V1 to >0.10 mV

ECGs of patients with atrial enlargement. Arrows, P-wave changes in atrial enlargement; asterisks, left-atrial enlargement.(click image to enlarge)

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