Enlargement of both left and right atria may cause recognizable changes in the electrocardiogram (ECG).


Changes in the ECG associated with bi-atrial enlargement:

(1) high-peaked P wave with an increased duration, especially in II, III and/or aVF (vertically oriented leads)

(2) large biphasic P wave in V1



• The increased duration of the P wave is related to changes in the initial and terminal aspects of the P wave.


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