Poor R wave progression
Also calledPRWP · poor R-wave progression · slow R wave progression · poor precordial R wave progression
Definition
Failure of the R wave amplitude to increase normally across the precordial leads. Definitions vary between studies; a widely used one is an R wave of 3 mm (0.3 mV) or less in V3 together with an R wave in V2 no taller than in V3. It is commonly attributed to anterior myocardial infarction, but it is nonspecific: it also occurs with left bundle branch block, pre-excitation (Wolff-Parkinson-White), left or right ventricular hypertrophy, faulty ECG recording technique, pulmonary disease, dilated cardiomyopathy, and in a small number of healthy people.
Sources
- Anttila I, Nikus K, Nieminen T, et al. Prevalence and prognostic value of poor R-wave progression in standard resting electrocardiogram in a general adult population. The Health 2000 Survey. Ann Med. 2010;42(2):123-130. doi.org/10.3109/07853890903555334
- MacKenzie R. Poor R-wave progression. J Insur Med. 2005;37(1):58-62. pubmed.ncbi.nlm.nih.gov/15895699/
- Wu X, Guo Y, Liang P, Ma H, Jiang P, Zhuan B. Analysis of factors associated with poor R-wave progression in precordial leads in patients with acute pulmonary thromboembolism: a retrospective study. BMC Cardiovasc Disord. 2026;26(1):770. doi.org/10.1186/s12872-026-06243-4
- de Alencar JN, Amorim EF, Scheffer MK, Felicioni SP, De Marchi MFN. Poor evidence for poor R wave progression in coronary disease: a scoping review. J Electrocardiol. 2024;84:145-150. doi.org/10.1016/j.jelectrocard.2024.04.007
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.