Ventricular premature complexes in trigeminal pattern
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The first complex in the lead II rhythm strip at the bottom is a wide QRS complex with a discordant ST segment and T wave suggesting a ventricular premature complex. This is followed by a pause and two normal sinus beats. Fourth complex is again a wide QRS complex with no preceding P wave and occurring prematurely, to be followed by a compensatory pause. This pattern follows with a grouping of three complexes each, with two normal sinus beats and one ventricular premature beat and a pause after that. This is ventricular trigeminy due ventricular premature complexes (ectopic beats). Though the automatic computer diagnostic algorithm has put a query on the first beat, it has correctly identified the last three premature ventricular complexes as PVCs. The VPCs have uniform morphology (monomorphic) and have a left bundle branch block pattern with inferior axis suggesting an origin from the right ventricular outflow tract, the common site of origin of benign ventricular premature complexes. The baseline sinus beats have a normal pattern.