Abstract: Objective To explore the electrocardiographic characteristics and clinical significance of apical hypertrophic cardiomyopathy and septal hypertrophic cardiomyopathy. Methods A total of 55 patients who met the diagnostic criteria of hypertrophic cardiomyopathy were selected from January 2017 to January 2019 in our hospital. According to different fat parts, patients were divided into apical hypertrophic group(17 cases, 30.91%) and septal hypertrophic group(38 cases, 69.09%). The clinical data, echocardiographic parameters and the parameters of Ⅲ lead, R/s, Q wave, S wave, V4-6,-aVR lead T wave were compared and analyzed. Results There was a significant difference in the interventricular septal thickness between the septal hypertrophic group [(15.71±4.88) mm] and apical hypertrophic group [(11.18±2.70) mm, t=8.701, P<0.05]. The proportion of V4-6(15 cases, 88.24%) and-aVR lead inverted T wave(16 cases, 94.12%) in apical hypertrophic group was statistically significant compared with septal hypertrophic group(χ²=7.275, 10.162, P<0.05). There was a significant difference in the proportion of R/s<1 in lead Ⅲ and main wave downward in septal hypertrophic group(21 cases, 55.26%) compared with that in apical hypertrophic group(4 cases, 23.53%, χ²=4.771, P<0.05). There was no significant difference in the other electrocardiographic parameters between the two groups(all P>0.05). Conclusion The electrocardiographic of apical hypertrophic cardiomyopathy is different from that of septal hypertrophic cardiomyopathy. It can provide a good indication for the early diagnosis of different types of hypertrophic cardiomyopathy and the location of hypertrophic sites through the T wave of lead V4-6,-AVR, the main wave direction of lead Ⅲ, combined with echocardiography and clinical data.