Should I be Worried?

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Author(s) A.A.M. Wilde, H.L. Tan
NHJ edition: 2006:01,033
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
The ECG can be enlarged twice by clicking on the image and it's first enlargement
Figure 1

A 34-year old man comes to your office. He has read in a newspaper about the familial occurrence of sudden death. He suffered a collapse during an episode of viral meningitis accompanied by high fever a few months earlier. A few years ago his elder brother, who was previously found to have idiopathic atrial fibrillation, died suddenly at the age 32 years. Physical examination reveals no abnormalities, including normal heart sounds. Echocardiographic evaluation reveals no abnormalities either. His baseline ECG is shown in figure 1.

What is your interpretation and what would be or should be your next step(s)?

Answer