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Figure 3 (A) Progressive electrocardiogram (ECG) change in adenosine monophosphate kinase disease: ECG of 19-year-old female with a short PR and left ventricular hypertrophy (upper) who developed a new rsR pattern and left-axis deviation by the age of 28 (lower). Her echocardiogram showed maximum left ventricular wall thickness (MLVWT) increasing from 14 to 17 mm. (B) Electrocardiogram of a 28-year-old female at time of initial assessment (upper), with an intraventricular conduction delay (IVCD) and a slurred QRS upstroke, which by age 35 years (lower) shows the development of a more widespread and bizarre IVCD, with diffuse T-wave inversion. This patient had no documented echocardiographic progression of disease, with MLVWT stable at 11 to 12 mm.