The patient was a 61-year-old man. Of special interest in his personal history was active tobacco use, moderate alcohol consumption, and chronic ischemic heart disease. He had had an acute anterior myocardial infarction 30 years earlier without revascularization. He later developed severe left ventricular systolic dysfunction (left ventricular ejection fraction of 15%) and experienced a syncopal event secondary to an episode of sustained monomorphic ventricular tachycardia. For this reason, he received a implantable cardioverter defibrillator- resyncronizer device in November 2013. In January 2014, he was admitted to another center due to inappropriate shocks secondary to atrial tachycardia. He came to the emergency department in May 2014 after having received several shocks from the device. The Figure shows the electrocardiogram recorded upon his arrival in the emergency department.
Suggest a solution to this ECG Contest at http://www.revespcardiol.org/es/electroreto/67/12 (only Spanish). The answer will be published in the next issue (January 2015) #ECGDIC14.