This is a good example of wide complex tachycardia that must be evaluated for V Tach vs supraventricular rhythm with left BBB.
There is an irregular rhythm. When the rate is fast, it is important to look at a longer strip, as sometimes fast rates will cause the rhythm to look regular. We know that monomorphic V Tach is not irregular, so that tells us that we are looking at atrial fibrillation.
The ECG criteria for left bundle branch block is met here: 1) supraventricular rhythm (atrial fib), 2) wide QRS, and 3) negative QRS in V1 and positive QRS in Leads V6 and I.
With wide complex tachycardia, there is always a chance of ventricular tachycardia, and the patient should be treated as V tach until proven differently. For more on determining whether a WCT is V tach or SVT with ventricular conduction delay, go to this LINK.
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