A 59-year-old male patient was referred to our hospital for treatment of paroxysmal atrial fibrillation since 8 years, with frequent presentations to the emergency department for cardioversion. Previously, post-cardioversion sinus bradycardia was observed. After extensive discussion of the treatment options, the patient opted for a minimally invasive surgical pulmonary vein isolation. The ECG shown was recorded during ablation of the left-sided pulmonary veins (Fig. 1).
Fig 1
ECG recording during surgical pulmonary vein isolation
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Question
What is the mechanism of this trigeminy rhythm?
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