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Left Atrial Enlargement

Left atrial enlargement is caused by pressure or volume overload and is often a precursor to atrial fibrillation. The ECG criteria for left atrial enlargement include a broad, bifid P wave in lead II over 40ms between peaks or total P wave duration over 110ms, and a biphasic P wave in V1 with a terminal negative portion over 40ms or 1mm deep.

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107 views3 pages

Left Atrial Enlargement

Left atrial enlargement is caused by pressure or volume overload and is often a precursor to atrial fibrillation. The ECG criteria for left atrial enlargement include a broad, bifid P wave in lead II over 40ms between peaks or total P wave duration over 110ms, and a biphasic P wave in V1 with a terminal negative portion over 40ms or 1mm deep.

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Fathimah afifah zahrah
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Left Atrial Enlargement

Left atrial enlargement (LAE) is due to pressure or volume overload of the left atrium.
LAE is often a precursor to atrial fibrillation.

Also known as: Left Atrial Enlargement (LAE), Left atrial hypertrophy (LAH), left atrial
abnormality.

P wave changes with Left Atrial Enlargement

ECG Criteria for Left Atrial Enlargement

LAE produces a broad, bifid P wave in lead II (P mitrale) and enlarges the terminal negative
portion of the P wave in V1.

In lead II

 Bifid P wave with > 40 ms between the two peaks


 Total P wave duration > 110 ms

In V1

 Biphasic P wave with terminal negative portion > 40 ms duration


 Biphasic P wave with terminal negative portion > 1mm deep
Causes of left atrial hypertrophy

In isolation:

 Classically seen with mitral stenosis

In association with left ventricular hypertrophy:

 Systemic hypertension
 Aortic stenosis
 Mitral incompetence
 Hypertrophic cardiomyopathy

ECG Examples

Example 1

 Broad (>110ms), bifid P wave in lead II (P mitrale) with > 40ms between the peaks

Exampe 2

P wave terminal portion > 40 ms duration in V1

Example 3
P waves with terminal portion > 1mm deep in V1

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