ECG of the Month: Irregular Rhythm in a 76-Year-Old With SIHD

A 76-year-old gentleman with a past medical history of coronary artery disease (CAD), diabetes, atrial fibrillation, and hypertension is admitted to the hospital for management of severe three-vessel CAD. Prior to admission, he developed unstable angina, which was evaluated by a nuclear stress test which was markedly positive. He was referred for left heart catheterization, which revealed three-vessel disease with a 99% stenosis in the distal left main artery, a 95% proximal stenosis in the proximal left anterior descending artery, an 80% stenosis in the ostial circumflex, and a 70% lesion in the proximal right coronary artery.

Figure 1

An ECG performed upon admission demonstrates which of the following:

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