ECG of the Month: A 32-Year-Old Woman Presents with New Onset of Cough, Fever and Fatigue

A 32-year-old woman presents with the new onset of cough, fever, and fatigue. She has a history of hypertrophic obstructive cardiomyopathy (HOCM) and had an implantable cardioverter defibrillator (ICD). She has had cardioversions for atrial fibrillation. She has had fever and malaise for one week. There is concern for a mass on the right ventricular (RV) lead. An electrocardiogram (ECG) is performed (Figure 1).

Figure 1

Figure 1

The ECG shows which of the following?

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