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Logo of jroyalcgpracBJGP at RCGPBJGP at PubMed CentralJ R Coll Gen Pract at PubMed CentralRCGP homepage
J R Coll Gen Pract. 1976 May; 26(166): 349–352.
PMCID: PMC2158191

Examination of the P wave in lead V1 of the electrocardiogram: its value in routine electrocardiography


While reporting on the electrocardiograms recorded in this Department during the past four-and-a-half years, interest was aroused by the occasional appearance of a terminal negative component in the P wave in lead V1. I tried to find out what significance, if any, it had. In the ensuing study a relationship between such a negative component—expressed as a terminal negative force (-ve Ptf V1 for short)—and the presence of ischaemic heart disease emerged. Such a negative Ptf V1 is not an in-fallible marker of ischaemic heart disease nor does it necessarily persist in the repeat electrocardiogram of any given patient. It is, however, suggested that attention be routinely paid to the morphology of the P wave in lead V1 and that when a negative terminal component is present in this wave follow-up study of this feature in serial electrocardiograms may help in the assessment of prognosis in any given patient.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
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  • Bethell HJ, Nixon PG. Electrical and mechanical aspects of left atrial activity. Br Heart J. 1974 May;36(5):507–511. [PMC free article] [PubMed]
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  • SUTNICK AI, SOLOFF LA. Posterior rotation of the atrial vector. An electrocardiographic sign of left ventricular failure. Circulation. 1962 Nov;26:913–916. [PubMed]
  • Garfield SR, Collen MF, Feldman R, Soghikian K, Richart RH, Duncan JH. Evaluation of an ambulatory medical-care delivery system. N Engl J Med. 1976 Feb 19;294(8):426–431. [PubMed]

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