Significance of a negative sinus P wave in lead V2 of the clinical electrocardiogram

Abstract

Background: A negative sinus P wave in lead V2 (NPV2) of the electrocardiogram (ECG) is rare when leads are positioned correctly. This study was undertaken to clarify the significance of an unusually high incidence of this anomaly found in ECGs at my institution. Methods: One thousand four hundred thirty-five ECGs were randomly selected to determine the incidence and gender frequency in tracings showing positive (PPV2), and biphasic (BPV2) P waves in V2, as well as NPV2. To those cases with NPV2, 84 cases with that anomaly from earlier archived ECGs were added to give a larger group for analysis. Medical records were reviewed for clinical details and other archived ECGs. Results: PPV2, BPV2, and NPV2 were found in 1,216 (84.5%), 150 (10.5%), and 69 cases (4.8%), respectively. Cases with NPV2 were more likely to be female (46 of 69 or 67.7%) than were those with either PPV2 (500 of 1,216 or 41.1%; p