I would not go 1st degree. I mean there's some brady before the v-tach stuff, but there's a long QT. P's a monomorphic but still sinus for most of it. There's suggestive LVH. I mean look at V5.
There's a lot of biphasic QRS's III & V1 maybe aVL so you are talking BBB. Anterior branch most likely.
Not sure about any of what I just posted. 32 yo male fits low on pre-test probability for the biggies. EKG should be a piece of the puzzle not the sole diagnostic. I mean, if you create an overall HPI it will help out. Also knowing if troponin's 3x are ok. PMH? Home meds? Etc.
I'm all over the map trying to come up w/ stuff just on an EKG alone. Based on just knowing 32 yo male, I'd go electrolyte imbalance. Hypokalemia. T's are really flat or inverted. (???)