ECG of the Month: Palpitations and Chest Pain

This is 80-year-old male with a history of coronary artery disease, s/p coronary artery bypass grafting, type II diabetes, hypertension, hyperlipidemia and paroxysmal atrial fibrillation. The patient recently had a dual-chamber pacemaker placed for symptomatic sinus bradycardia. Patient was seen in clinic and noted to have palpitations and chest pain. An ECG was obtained at the time of his clinic visit (A). An ECG prior to pacemaker placement is included for comparison (B).

A

Figure 1

B

Figure 2

The ECG obtained in clinic (A) shows which of the following:

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