ECG of the Month: 77-Year-Old Woman with History of Rheumatoid Arthritis, Breast Cancer, and Palpitations Presents to ED with Nausea and Vomiting

A 77-year-old woman with a history of chronic rheumatoid arthritis and breast cancer presents to the emergency department with complaints of nausea and vomiting. She has had palpitation for some years and was treated with digitalis. An ECG is performed and depicted below (Figure 1).

Figure 1

Figure 1

The ECG shows bifascicular block and which of the following:

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