Patient presents with chest pain – has pacemaker in situ

What does the ECG image below show?

Paced ECG

  1. It is diagnostic of ST-elevation infarction of the high-lateral wall;
  2. One cannot diagnose an infarction from ventricularly-paced complexes.

Correct answer is 1.
It is well known that QRS complexes originating from the ventricle, such as premature ventricular contractions, or QRS complexes during an accelerated ventricular rhythm, ventricular tachycardia, or ventricularly-paced rhythm, can, at times, reveal myocardial injury and help one diagose ST-elevation infarction (if consistent with the clinical scenario).