Accelerated Idioventricular Rhythm (AIVR) with Isochronic AV Dissociation

Interpretation

Sinus P waves march regulary at rate of 90/min in competition with an Accelerated Ventricular Focus at the same rate (Isochronic AV Dissociation), resulting in numerous Ventricular Fusion Complexes, so the rhythm is Accelerated Idioventricular Rhythm (AIVR) with Isochronic AV Dissociation.
There is Concordant ST Elevation in V1, with excessively discordant ST elevation in V2 to V4 that meets Sgarbossa Criteria, so it’s probably Anterior MI.