A patient s/p AVR. What is this rhythm?
This is regular wide QRS complex rhythm (~68 bpm) with no discernible P waves. It has a RBBB pattern (qr in V1) and it does not fit the RBBB-VT criteria for VT wich could either be monophasic R, QR and the rabbit-ear morphology. Thus, this is atrial fibrillation, complete heart block, accelerated junctional rhythm with bundle branch block (likely RBBB). A pacemaker was later implanted.