ECG of the Month: Patient Presents with Palpitations and Dyspnea

A 61-year-old man presents to the emergency department with several days of palpitations and dyspnea. His past medical history is remarkable for an atrial fibrillation ablation three years ago, hypertension, hyperlipidemia, and obesity. Echocardiogram revealed normal left ventricle and right ventricle size and systolic function, with no significant valvular abnormalities.

A 12 lead ECG was obtained (Figure 1).

Figure 1:

Figure 1

The ECG shows which of the following?

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