This 62-year-old hypertensive diabetic man is referred to the cardiac clinic because of frequent episodes of near-syncope during the past week. He had aorto-coronary bypass surgery 9 years earlier and had been stable and free of chest pain since:

• Sinus rhythm
• High grade AV block – Ventricular rate 31/min
• Right bundle branch block
• Left anterior fascicular block

The patient is admitted to Hospital. ECG 2 is recorded in the CCU:

• Sinus rhythm
• High grade AV Block, with junctional escape complexes and ventricular escape complexes
• The first very wide escape QRS complex most likely originated in the left ventricle
• Ventricular rate 32/min
• Right bundle branch block
• Left anterior fascicular block