ECG of the Month: 89-Year-Old Woman Presents with a History of Hypertension and Hyperlipidemia

An 89-year-old woman presents with a history of hypertension and hyperlipidemia. She is admitted because of "an irregular heart beat" and difficulty with speech as noted by her family. An echocardiogram (ECG) shows left ventricular diastolic dysfunction and left atrial enlargement.

A 12 lead ECG was obtained (Figure 1).

Figure 1:

Figure 1

The ECG shows which of the following?

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