Biatrial Enlargement (Pediatric) – The Premier EKG Resource for Medical Professionals

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Biatrial Enlargement (Pediatric)

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.

Categories:
EKG Middle3 Left
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Dr. Anthony Kashou (The EKG Guy) is a physician resident at the Mayo Clinic in Rochester, Minnesota. He is on a mission to transform ECG education and filling the gap exists around the world. Dr. Kashou has taught and developed curriculum for medical students, including 500+ lectures and 100+ hours of adult and pediatric ECG lessons.

At the Mayo Clinic, he pursues innovative ECG research and was awarded first place for his research at the Minnesota American College of Cardiology Conference 2018. His passion for medical education and innovation led to the development of EKG.MD, which provides a convenient and accessible forum to learn the fundamentals and foundations of ECG interpretation. He has also authored dozens of peer-reviewed articles for medical journals and textbooks, along with multiple ECG books for learners at all levels.

Dr. Kashou continues to lead and teach weekly ECG sessions and weekend seminars for residents, nurses, ECG interpreting technicians, and physician assistants at the Mayo Clinic. He has been asked and is currently developing an ECG board review course for cardiology fellows. He has an online following of over 275,000 individuals and is the founder of the largest, fastest growing ECG community in the world. His clinical research focuses on developing innovative ECG algorithms that can be integrated and implemented into clinical practice.

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