Left Atrial Enlargement

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

Example 2

Example 3

Related Topics

• The P Wave
• Right Atrial Enlargement
• Biatrial Enlargement
• Left Ventricular Hypertrophy

References

• Edhouse J, Thakur RK, Khalil JM. ABC of clinical electrocardiography. Conditions affecting the left side of the heart. BMJ. 2002 May 25;324(7348):1264-7
• Chung DC, Nelson HM. ECG – A Pictorial Primer [internet].
  

Advanced Reading

Online

• Wiesbauer F, Kühn P. ECG Mastery: Yellow Belt online course – Become an ECG expert. Medmastery
• Wiesbauer F, Kühn P. ECG Blue Belt online course: Learn to diagnose any rhythm problem. Medmastery
• Rawshani A. Clinical ECG Interpretation ECG Waves
• Smith SW. Dr Smith’s ECG blog.

Textbooks

• Mattu A, Tabas JA, Brady WJ. Electrocardiography in Emergency, Acute, and Critical Care. 2e, 2019
• Brady WJ, Lipinski MJ et al. Electrocardiogram in Clinical Medicine. 1e, 2020
• Straus DG, Schocken DD. Marriott’s Practical Electrocardiography 13e, 2021
• Hampton J. The ECG Made Practical 7e, 2019
• Grauer K. ECG Pocket Brain (Expanded) 6e, 2014
• Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography 1e, 2009
• Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric 6e, 2008
• Mattu A, Brady W. ECG’s for the Emergency Physician Part I 1e, 2003 and Part II
• Chan TC. ECG in Emergency Medicine and Acute Care 1e, 2004
• Smith SW. The ECG in Acute MI. 2002 [PDF]

LITFL Further Reading

• ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
• ECG A to Z by diagnosis – ECG interpretation in clinical context
• ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
• 100 ECG Quiz – Self-assessment tool for examination practice
• ECG Reference SITES and BOOKS – the best of the rest