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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

The patient is female in her 80s with a medical hx of previous MI with PCI and stent placement. She also has a hx of paroxysmal atrial fibrillation and is on oral anticoagulant treatment. She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG below was recorded.

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A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

Edits by Meyers and Smith A man in his 70s with PMH of hypertension, hyperlipidemia, type 2 diabetes, CVA, dual-chamber Medtronic pacemaker, presented to the ED for evaluation of acute chest pain. LAFB, atrial flutter, anterolateral STEMI(+) OMI. Sent by Pete McKenna M.D. Triage ECG: What do you think?