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Home | ECG Library | ECG Basics | Left Atrial Enlargement

Left Atrial Enlargement

by Dr Ed Burns, last update February 5, 2019

↪  ECG Basics Homepage

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
P wave morphology LAE Wagner 2007

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
ECG strip bifid P wave p mitrale
  • Broad (>110ms), bifid P wave in lead II (P mitrale) with > 40ms between the peaks

Example 2

P wave terminal portion
P wave terminal portion > 40 ms duration in V1

Example 3

P waves with terminal portion more than 1mm deep in V1
P waves with terminal portion > 1mm deep in V1

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. PMC1123219
  • Chung DC, Nelson HM. ECG – A Pictorial Primer [internet].

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

Advanced Reading
  • Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
  • Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
  • Wagner GS. Marriott’s Practical Electrocardiography 12e
  • Chan TC. ECG in Emergency Medicine and Acute Care
  • Rawshani A. Clinical ECG Interpretation
  • Mattu A. ECG’s for the Emergency Physician
  • Hampton JR. The ECG In Practice, 6e

ECG LIBRARY 700

ECG LIBRARY

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About Dr Ed Burns

Dr Ed Burns . Emergency Physician in Pre-hospital and Retrieval Medicine in Sydney, Australia. He has a passion for ECG interpretation and medical education.

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