This wide QRS complex tachycardia has a typical left bundle branch block pattern, but two things give the clue that this is ventricular tachycardia. There is a fusion beat (second from left) present and AV dissociation can be imagined as well. The Bragada morphology criteria are not met. Remember to interpret the ECG in the appropriate clinical context and treat a wide QRS complex tachycardia like ventricular tachycardia until proven otherwise.
A fusion beat (a.k.a. Dressler beat) can occur during ventricular tachycardia. The sinus node activity (P wave) can begins to conduct through the normal conduction pathway during an episode of ventricular tachycardia. The abnormal ventricular impulse then conducts retrograde across the AV node and the resulting QRS is a “fusion beat” of the normal QRS morphology and that of the ventricular morphology from the ventricular tachycardia.
