This is an electrocardiogram from a woman in her forties who had several operations for congenital heart disease. At the time of the electrocardiogram the patient was taking flecainide and metoprolol . This patient was being treated for ventricular tachycardia. She was initially treated with amiodarone and then was switched to a combination of flecainide and metoprolol. She was doing well. The underlying congenital heart disease was Tetralolgy of Fallot. The electrocardiogram shows a supraventricular rhythm which is probably not sinus as indicated by the negative P waves in the inferior leads. The cardiogram also shows 1 PVC and a right Branch block with a left anterior hemi-block.