Abstract
A 60-year-old woman presented with palpitations. Physical examination and routine laboratory tests were unremarkable. Her electrocardiogram revealed a wide complex tachycardia with a right bundle/right axis morphology and cycle length alternans of 380 ms and 460 ms (Figure 1). After spontaneous termination, telemetry revealed sinus rhythm with first-degree atrioventricular block, right bundle branch block, and left posterior fascicular block for several hours. The patient then complained of lightheadedness, and the surface electrocardiogram revealed sinus rhythm with complete atrioventricular block and a ventricular escape rhythm (Figure 2).
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