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A 70-year-old male presents with a 4-hour palpitation with sweating and, on direct questioning, mild chest tightness.
He states he has several previous episodes of palpitations and has been told he has SVT and he responds to adenosine.
He has a previous history of myocardial infarction and chronic obstructive pulmonary disease.
He drinks two bottles of wine a day and smokes 30 cigarettes a day.
He is hypotensive on presentation and has some evidence of cardiac failure.
His ECG is as shown, the rate is 150 bpm. Click on the ECG to enlarge.
Which one of the following is the most likely ECG diagnosis?
Which three ECG findings support your diagnosis?