Poor R Wave Progression

Synonyms and keywords: PRWP, poor R wave transition, delayed R wave transition, delayed transition

Overview
Poor R wave progression across the precordium refers to an electrocardiographic finding where the normal increase in R wave amplitude as one progresses from V1 to V6 is lost. Although non-specific, this finding is consistent with a prior anterior myocardial infarction.

Definition
The definition of poor R wave progression (PRWP) varies in the literature, but a common one is when the R wave is less than 2–4 mm in leads V3 or V4 and/or there is presence of a reversed R wave progression, which is defined as R in V4 < R in V3 or R in V3 < R in V2 or R in V2 < R in V1, or any combination of these.

Differential Diagnosis
Poor R wave progression can be observed in the following settings:
 * Faulty ECG recording technique
 * Left bundle branch block
 * Myocardial infarction
 * Right and left ventricular hypertrophy
 * Wolff–Parkinson–White syndrome