An 85-year-old man presented to the clinic with exertional dizziness and episodes of syncope. He is now homebound due to the severity of his symptoms. He also complained of mild shortness of breath (SOB) and lower limb swelling of several weeks' duration.
What is the most likely ECG diagnosis?
Choose the correct answer.
Initial rhythm is slow sinus rhythm with heart rate significantly below 60 bpm. There is clear sinus pause between the 5th and 6th complex in long lead II. The pause is not exactly multiples of previous P-P intervals, it suggests a sinus arrest rather than sinoatrial exit block. The last beat is a junctional escape beat with possibly a retrograde P wave.
