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Biatrial enlargement is diagnosed when criteria for both right and left atrial
enlargement are present on the same ECG.
The diagnosis of biatrial enlargement requires criteria for LAE and RAE to be met in
either lead II, lead V1 or a combination of leads.
The spectrum of P-wave changes in leads II and V1 with right, left and bi-atrial enlargement is
summarized below:
In lead II
In V1
Combination criteria
ECG Examples
Example 1
Biphasic P waves in V1 with a very tall positive deflection (almost 3 mm in height!) and
a negative deflection that is both deep (> 1 mm) and wide (> 40 ms).
Example 2
Biatrial enlargement:
P waves in lead II are tall (> 2.5mm) and wide (> 120 ms).
P waves in V2 are tall (> 1.5 mm), while the terminal negative portion of V1 is deep (>
1mm) and wide (> 40 ms).