The electrocardiography study of atrial arrhythmias has been hindered by the frequent occurrence of a "hidden". P wave in standard lead recordings. We present a modified method of surface electrocardiography that proved helpful in our prospective study of 26 consecutive patients in whom traditional surface recordings did not show the atrial mechanism. We recorded leads I, II, and III in their customary positions, except that we repositioned a pertinent limb electrode at a precordial site, in order to identify a P wave. The 4 alternative sites that we found most helpful were at the high and low parasternal positions, both to the right and to the left of the sternum. Confirmatory examples are submitted.
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