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Figure 2 Unrecognized atrial fibrillation underlying atrioventricular sequential paced rhythm. In the precordial leads there is the appearance of organized atrial activity followed by ventricular pacing. This was interpreted as sinus rhythm with premature atrial depolarization and DDD pacing. The pacemaker was reprogrammed to VVI revealing the underlying rhythm to be coarse atrial fibrillation.
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