16. Choice A is the correct answer. Since the P wave is atrial depolarization, the P wave is what we assess to determine hypertrophy. Lead V1 is over the atria, so it is the best indicator of hypertrophy. If the initial component of the P wave in V1 is the largest, it is right atrial hypertrophy. If the last portion of the P wave is biphasic in lead V1, this represents left atrial hypertrophy. With junctional tachycardia, there is inverted P waves occurring before, during or immediately after the QRS complex. There is a rate greater than 60. With a premature junctional contraction, the inverted P wave is only on one beat occurring earlier in the cycle.
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