Abnormal R wave Prominent V1-V2 R wave 2025-01-07T09:05:02Z Prominent R wave in lead V1 High voltage R wave in V1/V2 The R wave in leads V1-V2 is normally considerably smaller in amplitude than the S wave in the same leads. Prominent R wave in these leads implies the R wave is larger than the S-wave, which may indicate cardiovascular pathology. This term includes Tall R wave in lead V1, which is defined by a R/S ratio greater than 1. This electrocardiographic finding exists as a normal variant in only 1% of patients. Physicians should therefore be familiar with the differential diagnosis for this important QRS configuration. The electrocardiographic entities which can present with this finding include right bundle branch block, left ventricular ectopy, right ventricular hypertrophy, acute right ventricular dilation (acute right heart strain), type a Wolff-Parkinson-White syndrome, posterior myocardial infarction, hypertrophic cardiomyopathy, progressive muscular dystrophy, dextrocardia, misplaced precordial leads, and normal variant.