EKG in biatrial enlargement

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Overview
In biatrial enlargement, the ECG has signs of both left and right atrial enlargement.

In lead V1 the following are observed:
 * The P wave is biphasic with a large initial positive peak followed by a negative deflection.
 * The P wave is more than 0.04 seconds in duration.
 * The positive initial part of the P wave is > 1.5 mm and the negative terminal part of the P wave is > 1 mm.





Additional Reading

 * Moss and Adams' Heart Disease in Infants, Children, and Adolescents Hugh D. Allen, Arthur J. Moss, David J. Driscoll, Forrest H. Adams, Timothy F. Feltes, Robert E. Shaddy, 2007 ISBN 0781786843
 * Hurst's the Heart, Fuster V, 12th ed. 2008, ISBN 978-0-07-149928-6
 * Willerson JT, Cardiovascular Medicine, 3rd ed., 2007, ISBN 978-1-84628-188-4