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Culprit Pauses!

A 78-year-old lady presented with a several-day history of “not feeling well.” On the day of admission she had several spells of syncope at home. She was admitted for observation and further evaluation.

Her past medical history included arterial hypertension and mild dementia; otherwise she was healthy. Her physical examination was unremarkable and her echocardiography was within the normal limits for her age.

In the hospital she developed the rhythm shown below in Fig. 1.


1-What is the interpretation of the rhythm strips?
2-Will this patient need an implantable cardioverter defibrillator (ICD)?


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