Reassessment of electrovectorcardiographic signs of left atrial enlargement

Abstract

Summary: Echocardiographic left atrial size was correlated with 27 electrovectorcardiographic parameters in 93 subjects. In 20 of them hemodynamic studies, including calculation of the left atrial volume, were performed. Subjects were divided into four groups as follows: Group I, 21 healthy subjects; group 11,45 patients with heart disease but no left atrial enlargement; group III, 15 patients with heart disease and left atrial size from 4.1 to 5 cm; and group IV, 12 patients with heart disease and a left atrial size exceeding 5 cm. A good correlation was found between left atrial size and the following parameters: Duration of P wave in standard lead II, voltage of both terminal forces of P wave in lead V I and its maximal vector in the frontal and sagittal planes. A new index (duration/voltage of P wave in lead II) was postulated, which showed an excellent correlation with left atrial size (p<O.ool). In all cases the superposition between groups was excessive. These findings indicate the limitations of the classical patterns and raise interest in new parameters concerning the electrocardiographic diagnosis of left atrial enlargement.

Usefulness of electrocardiographic parameters as compared with computed tomography measures of left atrial volume enlargement: from the ROMICAT trial

“…Multiple criteria have been established for the diagnosis of LAE 3–4. Both quantitative (P duration >110 ms in lead II, P to PR segment ratio >1.6 in lead II, P wave area > 4 ms × mV in lead II, and the P terminal force in lead V1 [PTFV1] > 40 ms × mm) and qualitative (bifid P wave in lead II, and biphasic P wave in V1) measures of LAE have been described to be a surrogate marker for LAE on surface ECG 5–9. P duration >110 ms and P to PR segment ratio have both been shown to be correlated with LAE 5–8.…”