This 71-year-old man with a known history of coronary artery disease and a previous myocardial infarction is seen in the emergency department following an episode of syncope at home. He collapsed and hit the back of his head. He reports regaining consciousness “within seconds”:

• Sinus rhythm with second Degree AV Block Mobitz II
• One premature ventricular complex
• Left axis deviation
• Right bundle branch block
• Anterior infarction, age undetermined
• Inferior infarction, age undetermined

A pacemaker was inserted, and the following ECG was recorded:

• AV sequential pacemaker
• Sinus rhythm, 60/min
• AV-sequential ventricular pacing