1. Normal sinus rhythm
2. Left atrial enlargement with P-mitrale pattern
3. Premature ventricular contraction
This patient had severe mitral stenosis from rheumatic mitral valve disease causing massive left atrial enlargement.
Note the morphology of the PVC in lead V1. The R is greater than the R' in a right bundle branch block pattern which is one of the Brugada criteria for a ventricular origin of a QRS complex (see Ventricular Tachycardia review below).
