A 75-year-old man with a longstanding history of coronary artery diseases is in the emergency department complaining of weakness, dyspnea and occasional faintness during the past 2 days: 

• Very slow ectopic atrial rhythm (atrial rate 21/min)  with junctional escape complexes (escape-capture bigeminy)
• Ventricular rate 42/min
• Left axis deviation
• Right bundle branch block
• Anterior infarction, age undetermined

Comment: The patient was admitted to the coronary care unit. On the following day an electronic AV sequential pacemaker was implanted. There were no complications.