P terminal force in lead V 1

Abstract

The P wave in valvular heart disease was analyzed by Morris et al. 1 Morris J.J. Estes E.H. Whalen R.E. Thompson H.K. McIntosh H.D. P-wave analysis in valvular heart disease. Circulation. 1964; 24: 242-252 Crossref Scopus (240) Google Scholar They first described the use of the P terminal force in lead V1 and elegantly showed that this method of P-wave analysis had a high positive predictive value and a sensitivity of 92% for left atrial (LA) abnormality in the presence of left-sided heart disease. Although this is now an accepted criterion for LA enlargement, 2 Chou T. Electrocardiography in Clinical Practice, 4th ed. WB Saunders, Philadelphia, PA1996: 23-36 Google Scholar the P terminal force in V1 has a lower sensitivity of 69% when used for LA enlargement than for LA abnormality. 3 Munuswamy K. Alpert M.A. Martin R.H. Whiting R.B. Mechlin N.J. Sensitivity and specificity of commonly used electrocardiographic criteria for left atrial enlargement determined by M-mode echocardiography. Am J Cardiol. 1984; 53: 829-832 Abstract Full Text PDF PubMed Scopus (67) Google Scholar Mehta et al 4 Mehta A. Jain A. Mehta M.C. Billie M. Usefulness of left atrial abnormality for predicting left ventricular hypertrophy in the presence of left bundle branch block. Am J Cardiol. 2000; 85: 354-359 Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar clearly showed the usefulness of LA abnormality for predicting left ventricular hypertrophy in the presence of left bundle branch block. The criterion that most effectively distinguished between normal and left ventricular hypertrophy was the P terminal force in V1.