Four cases of the "hypoplastic left ventricle syndrome" associated with electro cardiographic evidence of left ventricular hypertrophy offer two hypotheses for the possible interpretation of left ventricular hypertrophy. However, neither can be proved without further electrophysiologic and conduction pathway investigation. The primary purpose of this paper is to warn against discarding the diagnosis of a hypoplastic left ventricle on the basis of an electrocardiographic interpretation of left ventricular hypertrophy.