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A pre-threadmill rhyhtm

This is a 57-year-old man with h/o DM, hyperlipidemia, and HTN. He had a normal LV and a negative stress test about 18 months ago. He has been complaining of shortness of breath on exertion for several months, which got worse over the last two months.

He was referred by his primary care doctor for a stress test.

On exam: BP: 130/60 HR, 116 bpm, the rest of the exam was otherwise normal.

He was in the stress lab ready for the stress test. The Tech wanted the EKG checked before putting him on the treadmill.

Pre-stress test EKG is shown below.

Figure 1

Fig.1 (2)

Which of the following is the LEAST likely underlying rhythm? *

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