You are an Intern and send your medical student to get an ekg on a patient complaining of palpitations. He comes back with a puzzled look on his face and says, "WHAT THE HECK IS GOING ON??" You explain to him that.......

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Interpretation:

This patient has a dual chamber (RA and RV) pacemaker set to sense the atrium depolerization and fire at a certain interval in the ventrical after atrial depolerization, also know as atrial sensed, ventricularly paced. If you notice the morphology of the p waves in two three and AVF are of the normal sinus axis. Also following every normal looking p wave is a pacer spike followed by a typical wide qrs pacer mediated depolerized ventricular tracing. This leads us to believe that this patient for some reason has a supraventricular tachycardia, most likely sinus tachy, with the pacemaker sensing every normal atrial depolerization and firing in sequence in the ventricles.