This 85-year-old woman had a ventricular pacemaker implanted 3 years ago after she developed third degree AV block during a stress test originally ordered due to dyspnea. She had no chest pain. The echocardiogram showed normal left ventricular function and mild mitral regurgitation. She is now doing well, and is active at home without symptoms:

• Sinus rhythm
• Second degree AV block Mobitz II, with varying 2:1 and 3:2 conduction
• Escape paced QRS complexes
• Right bundle branch block