R wave progression
Also calledR-wave progression · RWP · precordial R-wave progression
Definition
The normal, gradual increase in R-wave amplitude across the precordial leads from V1 toward V6, with a matching decrease in S-wave depth, as the QRS changes from mainly negative in V1 to mainly positive in V6 because left ventricular forces dominate. The transition zone, where R and S are about equal, usually lies at V3 or V4. Poor R-wave progression has no single agreed definition; one study defined it as an R wave of 0.3 mV (3 mm) or less in V3 with the R wave in V2 no taller than in V3. Slow or delayed R-wave progression is described with left bundle branch block, left anterior fascicular block and swapped precordial electrodes, and has traditionally been read as a sign of prior anterior infarction.
Clinical notePoor R-wave progression is nonspecific, its definitions vary between studies, and the evidence for it as a marker of anterior infarction or coronary disease is weak.
Sources
- Samesima N, God EG, Kruse JCL, et al. Brazilian Society of Cardiology guidelines on the analysis and issuance of electrocardiographic reports - 2022. Arq Bras Cardiol. 2022;119(4):638-680. doi.org/10.36660/abc.20220623
- Lin WC, Hsiung MC, Yin WH, et al. Electrocardiography score for left ventricular systolic dysfunction in non-ST segment elevation acute coronary syndrome. Front Cardiovasc Med. 2021;8:764575. doi.org/10.3389/fcvm.2021.764575
- 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
- Meek S, Morris F. ABC of clinical electrocardiography. Introduction. II: Basic terminology. BMJ. 2002;324(7335):470-473. doi.org/10.1136/bmj.324.7335.470
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.