From the Guidelines
V1-V2 criteria for left atrial enlargement (LAE) can indicate several structural heart problems, most notably mitral valve disease, particularly mitral stenosis and mitral regurgitation, as well as hypertensive heart disease, left ventricular dysfunction, and diastolic dysfunction 1.
Common Conditions Associated with LAE
- Mitral valve disease (mitral stenosis and mitral regurgitation)
- Hypertensive heart disease
- Left ventricular dysfunction
- Diastolic dysfunction
Other Conditions that May Cause LAE
- Aortic valve disease
- Congenital heart defects (e.g., atrial septal defects)
- Cardiomyopathies (especially hypertrophic cardiomyopathy)
- Chronic atrial fibrillation
ECG Findings for LAE
LAE is identified on ECG by a biphasic P wave in lead V1 with a prominent negative terminal force (P terminal force in V1), and sometimes by a notched P wave in lead V2, reflecting the enlarged left atrium's altered electrical activation pattern 1.
Diagnostic Gold Standard
Echocardiography remains the gold standard for confirming and quantifying left atrial enlargement, as ECG has limited sensitivity for detecting this condition 1.
Clinical Implications
Accurate diagnosis and management of underlying conditions are crucial to prevent complications and improve patient outcomes, particularly in cases of severe mitral stenosis or regurgitation, where timely intervention can significantly impact morbidity, mortality, and quality of life 1.
From the Research
Structural Heart Problems Indicated by V1-V2 Criteria for Left Atrial Enlargement (LAE)
The V1-V2 criteria for Left Atrial Enlargement (LAE) can indicate several structural heart problems, including:
- Left ventricular hypertrophy (LVH) 2
- Diastolic dysfunction 2, 3
- Mitral regurgitation 4, 5
- Mitral valve disease 4
- Aortic stenosis (AS) 5
- Cardiomyopathy 6
- Ventricular septal defect 6
- Patient ductus arteriosus 6
- Tricuspid regurgitation 4
Association with Cardiovascular Outcomes
Left atrial enlargement (LAE) is associated with increased risk of cardiovascular outcomes, including:
Diagnostic Accuracy of ECG Criteria
The diagnostic accuracy of ECG criteria for LAE is limited, with sensitivity ranging from 30.8% to 58.1% 3 and specificity of 100% 3. The presence of a notched P wave in the limb leads with a large negative terminal deflection in lead V1 is a predictive variable for LA enlargement 6.