The rhythm is atrial flutter with flutter waves seen best in the inferior leads and in leads V1 to V3. The atrial rate is about 250/min. The QRS is wide (>120ms) an there is a tall R' wave in V1 and a shallow S in V6. The axis of the QRS seems normal. The EKG shows a right bundle branch block.	Rate (/min)	54	QT (ms)	559
	pr (ms)	357	QRS axis (degrees)	80
	QRS (ms)	183