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The patient is an 82 year old female with a chief complaint of palpitations. Originally exertion induced, they now occur at rest. Patient is a poor historian with cognitive difficulties. She states palpitations occur daily. Patient reports feeling nausea during the episodes, denies shortness of breath and/or diaphoresis. Patient had mitral valve replacement 2 1/2 years ago, followed by implantation of an RV demand pacemaker. Patient's ejection fractions have decreased steadily since the surgery, and she is now in heart failure. EJ of 61% after surgery, now at 34%. Patient has no coronary artery disease, is normo-tensive, with normal renal and hepatic function. Medications include coumadin, lasix and various supplements (primarily K-dur and Iron). Patient's only other complaint is frequent constipation. Patient has an underlying controlled afib with a ventricular conduction delay. Her paced beats have a complex of around 120 mmsec. Native beats are also wide, around 115 mmsec. Now the question: Given the wide complex, if I am fortunate enough to capture an episode of tachycardia on the monitor, how can I tell if the tachycardia is atrial or ventricular in origin? Thank you for any help you can give me.