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Left ventricular hypertrophy is enlargement and thickening (hypertrophy) of the walls of your heart's main pumping chamber (left ventricle). Voltage Criteria · R wave in lead I + S wave in lead III > 25 mm · R wave in aVL > 11 mm · R wave in aVF > 20 mm · S wave in aVR > 14 mm. Left Ventricular Hypertrophy ECG Criteria. Left ventricular hypertrophy (LVH) is an abnormal thickening of the left ventricular myocardium that occurs as an adaptive mechanism to increased afterload. Left Ventricular Hypertrophy (LVH) · ≥ QRS amplitude (voltage criteria; i. The specificity is high (>85%).