An 86-year-old diabetic and hypertensive female with permanent atrial fibrillation (AF) presented to the emergency department with recurrent pre-syncope and one episode of syncope. The baseline electrocardiogram showed AF with a ventricular rate of 47 beats/min. Holter monitoring confirmed AF with a slow ventricular rate. The patient was then referred for single-chamber pacemaker implantation but the procedure was not uneventful. Fig. 1 shows the final position of the lead at the end of the procedure. What is the most likely diagnosis?
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S. Borges and J.I. Moreira declare that they have no competing interests.
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