Poor R wave progression refers to the absence of the normal increase in size of the R wave in the precordial leads when advancing from lead V1 to V6. In lead V1, the R wave should be small.

If downward in lead V1 (LBBB pattern), then VT is present in the following situations: The presence of any Q or QS wave in lead V6 favors VT. A wide R wave in lead V1 or V2 of 40 ms or more favors VT.

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