Bifid P Waves AKA P Mitrale

The P wave on ECG represents atrial depolarization. It is a first positive deflection with smooth contour. Changes in the normal morphology of P wave may indicate some underlying pathology. Bifid or notched P wave on ECG indicates left atrial enlargement. The notched appearance of P wave is attributed to longer time taken by left atrium as compared to the right atrium. The duration of P wave is usually longer than 120 ms. The bifid P waves can be appreciated in lead II. Reference: https://litfl.com/p-wave-ecg-library/ Image via: https://medschool.co/tests/ecg-basics/the-p-wave