It seems to be sinus bradycardia with atrial premature beats in a trigeminy-bigeminy pattern.

Fisrt: Poor quality ecg

Second: The rhythm is irregular sinus with premature atrial beats in fashion of intercalates bi or trigeminal mode

Third: Left Bound Branch Block

Fourth: Left Anterior Fascicular Block

Fifth: Fragmented QRS complex

Sixth: Left ventricular enlargement

Sinus bradycardia, left axis deviation, left anterior hemiblock , left atrial dilatation (V1- dominant negative phase), bifocal atrial premature beats as a trigeminy and bigeminy pattern.There are signs of left heart dilation and  LBBB.

Sinus rhythm with PAC's in pattern of bigeminy.  The IVCD is an atypical LBBB with septal infarction (q's in I, aVL). Left axis deviation suggests additional LAFB.

•  I`m agree with Dr. Frank G  Yanowitz: there are signs of Sodi-Pollarese indicating  a possible septal fibrosis/infarction on the LBBB 

According to the above, I'd add that premature atrial beats are multifocal in apparent normal non dilated atria by the basal p-morphology sinus rhythm.

QRS complex and ST segment should be focused 

It looks like sinoatrial exit block

there is delay in conduction of impulse in left antero superior fascicle of LBB. The qrs interval appears to be prolonged and there is superior axis deviation. The rhythm is sinus with every alternate impulse experiencing delay. 

Sinus rhythm with premature atrial beats (SVES) and LBBB morphology 

Thank you so much for all highly enlightening answers. I learnt a lot.

CHB...consider pacing

Episodes of sinus rythm block , premature atrial beats , LBBB.

Consider Holter or ecg loop recording before evaluating pacing.

regards

GP Carboni

Sinoatrial exit block with complete LBBB. hotter monitoring will be helpful

2:1 HB

ATRIAL FIBRILLATION, LEFT BUNDLE BRANCH BLOCK

Premature atrial beats and LBBB