Inverted P Wave in Lead 1

Report:

Sinus rhythm 97/min

Inverted P wave in L1 ?cause

P axis +100o

Left ventricular hypertrophy voltage

Comment:

In L1 atrial deflections are biphasic, mostly negative; elsewhere the P wave, while atypical, would pass muster were it not for the L1 negativity. It is biphasic – negative-positive – in the left precordial leads too. This may well be an atrial, rather than sinus rhythm. It remained stable over at least four months (Fig 43a below).

The patient had COCM secondary to left ventricular non-compaction, an increasingly recognised condition44. High voltage may be prognostically favourable in COCM.

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