At a first glance the Wide QRS Tachycardia is grossly irregular and cannot be ventricular tachycardia. The P-P cycle is difficult to measure, but appears to be regular at a rate of 250/min.
This elderly man has Atrial Flutter with variable A-V Conduction, as is depicted in the ladder diagram.
Basically, there is 2:1 conduction with episodes of 3:2 Wenckebach conduction.
The QRS is wide as a result of Left Bundle Branch Block (LBBB).
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