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This ECG is representative of sinus rhythm with second-degree atrioventricular block with 2:1 conduction; possible left atrial enlargement; and ST-T wave abnormalities suspicious for lateral ischemia.
Sinus rhythm is evidenced by the P waves that march through at a rate that is consistently double that of the QRS rate (82 beats/min). The PR interval in the conducted beats remains constant, with every other P wave blocked from conducting into the ventricles.
The biphasic P wave seen in lead V1 does not meet criteria for left atrial enlargement (P wave in lead I ≥ 110 ms, terminal negative P wave in lead V1 ≥ 1 mm2) but is suspicious. Finally, ST-T wave elevations in leads V2-V4 are suspicious for ventricular septal ischemia.
The patient underwent placement of a dual-chamber permanent pacemaker. He has done well since.
