The rhythm is sinus rhythm at about 65/minute, with a PR interval of 200 ms. The QRS has a left axis deviation. There is a poor R wave progression across precordial leads. This suggests a left aterior hemi-block and a possible remote aterior wall myocardial infarction. There is also a multiform ventricular couplet (second and third beat) as well as a blocked PAC seen in the ST segment of the 6th beat. The 9th beat is a ventricular premature beat.