Electrocardiogram of a 78 year-old man with hypertension, hyperlipidemia, coronary artery disease, previous myocardial infarction, left ventricular systolic dysfunction, recurrent acute congestive heart failure, recurrent paroxysmal atrial fibrillation, non-sustained ventricular tachycardias and COPD.

Rate 43/min
PR 0.25 sec
QRS 0.20 sec
QT 0.54 sec
QTc 0.45 sec
QRS axis - 30º

Interpretation: Abnormal ECG. Sinus bradycardia. First degree AV block. Borderline left axis deviation. Possible old inferior wall myocardial infarction. LBBB with markedly prolonged QRS duration and secondary repolarization changes.

The patient was considered for biventricular pacing and implantable defibrillator but decided against the recommended treatment. Patient continued on medical therapy, but died in his sleep.

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