Electrocardiographic findings in biventricular hypertrophy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Biventricular hypertrophy is suggested if:

1. There are voltage criteria for left ventricular hypertrophy (LVH) in the chest leads as well as right axis deviation in the limb leads.
2. There are voltage criteria for LVH in the chest leads combined with prominent R waves in the right chest leads.
3. There is a shallow S wave in lead V1 associated with a deeper S wave in V2, the so called shallow S wave syndrome.
4. One of the best criteria according to Marriott is left atrial enlargement (LAE) as the sole representative of left ventricular enlargement, combined with any of the following clues to right ventricular hypertrophy (RVH):
   • S/R ratio of 1.0 or more in V5 or V6
   • An S wave in V5 or V6 of 7 mm or more
   • Right axis deviation

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