Single lead VDD pacing is an established therapy in patients with AV block. Body position may influence the amplitude of the atrial signal recorded through the floating atrial electrode. This study analyzed the degree of posture related variation in the signal amplitude of floating atrial electrodes in 63 patients (mean age 72 ± 21 years) implanted with a VDD system. The average atrial amplitude in the supine position was 1.59 ± 1.15 mV and decreased significantly in the sitting position (1.37 ± 1.08, P < 0.014), right decubitus (1.33 ± 0.83, P < 0.007), and the abdominal position (1.24 ± 0.86, P < 0.001). The left side decubitus showed a nonsignificant increase in atrial amplitude (1.66 ± 2.02, P < 0.64). Body position significantly affects P wave amplitude and may be the cause of intermittent atrial undersensing. P wave amplitude measurement in different body postures should be performed in cases where suspected atrial undersensing occurs.