Overview:

• ECG criteria for atrial enlargement assumes sinus rhythm present
• No significant age-related differences for P wave amplitude to define RAE or LAE in children; therefore, apply adult RAE & LAE diagnostic criteria for all ages

ECG features:
Biatrial enlargement = RAE + LAE

RAE:

• P wave amplitude:
• (1) >2.5 mm in II, or
• (2) Initial positive deflection >1.5 mm in V1 or V2

LAE:

• Negative portion of P wave in V1: [depth (mm)] x [duration (s)] > -0.04 mm∙s
• Notched P waves in II with duration >95th percentile for age
• 95th percentile: birth, 65 ms; 12-16 y/o, 95 ms [1]
• Limited sensitivity (44%), but acceptable positive predictive value (85%) [2]

REFERENCES

1. Liebman J. Atrial hypertrophy. In: Liebman J, Plonsey R, Gillette P (eds): Pediatric Electrocardiography. Baltimore, Williams & Wilkins, 1982, p 140.

2. Maok J, Krongrad E. Assessment of electrocardiographic criteria for left atrial enlargement in childhood. Am J Cardiol 53:215, 1984.