An Irregular Rhythm at Older Age

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Author(s) A.A.M. Wilde
NHJ edition: 2007:4,157
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

An 86-year-old man presents in your outpatient clinic with stable angina pectoris (NYHA 2/4). There is no further medical history with the exception of hypertension for which he is being treated with metoprolol 100 mg daily. Physical examination reveals no abnormalities. His ECG is shown in figure 1 (only extremity leads).

What is your electrocardiographic diagnosis?