In healthy patients with normal anatomy, the right ventricle has less mass than the left ventricle. Consequently, the ECG leads do not normally detect impulses with significant voltage from the right ventricle. ECG indicators of right ventricular hypertrophy (RVH) are only present when the right ventricle has significant hypertrophy and attained a mass close to or greater than the mass of the left ventricle. RVH develops chronically over months or even years.
Significant RVH can be accurately diagnosed by ECG. However, the ECG diagnosis of less severe RVH is not reliable. The incidence of RVH is less common than LVH.