Complex ventricular ectopy
(Click on the image for an enlarged view)
Multiple wide bizarre QRS complexes without preceding P waves are ventricular ectopic beats. Since they have different morphologies, they are unlikely to be amenable for radiofrequency catheter ablation. Some of the couplets are seen to be bidirectional while others are unidirectional. In addition, there are QS complexes in V1 and V2 with a slightly coved ST segment and T wave inversion, reminiscent of an old myocardial infarction. Such complex ventricular ectopy occurring frequently over a long period of the order of a decade can predispose to tachycardiomyopathy. On the other hand the ectopy can be an association of familial dilated cardiomyopathy.