Abstract
The patient was a 64-year-old man with a history of myocardial infarction and subsequent episodes of atrial fibrillation and sinus bradycardia. A permanent ventricular inhibited rate responsive pacemaker was inserted 6 months before the outpatient visit, during which the electrocardiogram (ECG) shown in Figure 1 was recorded. He had been taking sotalol 160 mg twice per day for maintenance of sinus rhythm. The patient was asymptomatic apart from somewhat reduced exercise tolerance. His pacemaker was functioning as originally programmed. No changes were made, and he was sent home with instructions for routine follow-up. The cardiogram was originally thought to show sinus rhythm 67 beats/min with marked (0.44 sec) first-degree arteriovenous block and an appropriate paced escape beat at the end of the recording; deep symmetric T-wave inversion in multiple leads re
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