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The rhythm strip at the bottom shows three ventricular ectopic beats (first, fourth and eighth). These beats are not preceded by a P wave and have a morphology which different from the dominant rhythm in all leads except V1, in which the two types of QRS complexes are quite similar. These ventricular premature beats are presumably arising from the left ventricle in view of right bundle branch block pattern.

The negative P waves in V1 indicates left atrial overload possibly secondary to left ventricular dysfunction. The slurred S wave in lead I and slurred R wave in V1 in the dominant rhythm (sinus rhythm) indicates right bundle branch block (RBBB). rS complexes in inferior leads suggest associated left anterior hemiblock (LAHB). Together they constitute bifascicular block. QS complexes are seen in V6, along with coved ST segment and T wave inversion as seen in lateral wall myocardial infarction. Coved ST segment with T wave inversion is seen in V5 while ST segment depression and T wave inversion are seen in V4.