Posterior Rotation of the Atrial Vector

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Abstract
The electrocardio-grams of 26 patients with a clinical diagnosis of acute left heart failure were examined to determine if there were any ecg signs that could distinguish the tracing taken during failure from that taken during compensation. In 21 (81%), failure was associated with a posterior rotation of the mean atrial vector in the horizontal plane, demonstrated by an increase in P-wave negativity in V1 or persistence of a negative deflection of the P wave farther to the left in the precordial leads. Atrial fibrillation and increased notching associated with failure occurred in some patients, but were also accompanied by posterior rotation of the P vector when sinus rhythm was restored. Other atrial abnormalities present were not significantly changed during failure. Posterior rotation of the atrial vector is an important electrocardiographic sign of acute left ventricular failure.