ECG of the Month: Pedal Edema

A 58-year-old man with a history of atrial fibrillation presents for a routine clinic visit. The patient is on amiodarone and has a history of end-stage renal disease status post renal transplant (2011), gastric neuroendocrine tumor, squamous cell cancer status post Mohs surgery, coronary artery disease, cryptogenic cirrhosis, bioprosthetic aortic valve replacement, and hypothyroidism who took metolazone dose in addition to his usual twice daily torsemide for worsening of pedal edema.

The following ECG is performed:

Figure 1

The ECG shows which of the following?

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