A 94 year old man with a history of atrial fibrillation and symptomatic bradycardia presents to the emergency department with palpitations and shortness of breath. His ECG is shown below: 

• Atrial fibrillation with ventricular paced rhythm, ventricular rate 82/min 
• Fusion beats (example beats 2 and 7) and Pseudofusion beats (example beats 5, 8, and 11) are present 
• Native QRS complexes show anteroseptal infarction 

Comment: Positive complexes noted in V1 and V2 likely related to superior positioning of these leads – all other leads consistent with RV apical pacing.