Evaluation of electrocardiographic criteria for right atrial enlargement by quantitative two-dimensional echocardiography

Abstract

Using quantitative two-dimensional echocardiography, we found that most previously reported ECG criteria for right atrial enlargement have low predictive power. The best predictors of right atrial enlargement were a P wave height > 1.5 mm in lead V2 and, as new criteria, a QRS axis > 90 degrees and an R/S ratio > 1 in lead V1 in the absence of complete right bundle branch block. The combined sensitivity of these three criteria was 49%, with preservation of 100% specificity. Further studies are needed to prospectively validate these findings.

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: Definition, characterization, and clinical implication

“…Right atrial volumes are also underestimated with 2D echocardiographic techniques compared with 3DE. 343,406,407 …”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…Right atrial volumes are also underestimated with 2D echocardiographic techniques compared with 3DE. 343,406,407 Cardiac computed tomography Cardiac CT may be used for accurate assessment of atrial volumes. Volumetric data from cardiac computed tomography (CCT) are comparable to data generated by CMR and 3D echocardiographic imaging and is superior to 2D echocardiography.…”

Evaluation of Right Atrial Size in Patients with Atrial Arrhythmias: Comparison of 2D versus Real Time 3D Echocardiography

“…Right atrial size can be assessed from many different views but is most commonly performed from the apical four‐chamber view 6 . It has been evaluated in several small studies using standard echocardiography by apical long‐ and short‐ (minor) axis diameters, 2,7,8 four‐ chamber planimetry area, 7,8 and by single plane two‐dimensional (2D) volume determination methods (area length method or method of discs) 9–11 . As there are no standard orthogonal right atrial views biplane volume calculation has not been used.…”

“…6 It has been evaluated in several small studies using standard echocardiography by apical long-and short-(minor) axis diameters, 2,7,8 four-chamber planimetry area, 7,8 and by single plane two-dimensional (2D) volume determination methods (area length method or method of discs). [9][10][11] As there are no standard orthogonal right atrial views biplane volume calculation has not been used. Assessment of volumes would be a robust and accurate way for the determination of right atrial size, as stated by the recently revised ASE guidelines.…”