This 79-year-old man is admitted with infective endocarditis and a para-aortic abscess. He underwent aortic valve replacement and debridement of the abscess:

• Atrial Flutter
• Complete heart block with escape accelerated junctional rhythm (76/min}
• Poor R wave progression from V1 to V3 – possible septal infarction, age undetermined
• T wave abnormality, consider antero-lateral ischemia

ECG 2 is recorded one day later: 

• Sinus rhythm with complete heart block
• Junctional escape rhythm, 55/min
• Poor R wave progression from V1 to V3 – possible septal infarction, age undetermined
• T wave abnormality, consider anterior ischemia

A surgical procedure is carried out on the following day:

• DDD Pacing (atrial sensed, ventricular paced rhythm)
• Premature atrial complex