A 44-year-old male presented with palpitations . His medical history was uneventful, and family history revealed pacemaker implants in two of his uncle's (fifties) and one of his brothers (mid-forties). His father was 74 years of age and without cardiac complaints. Physical examination revealed no abnormalities. After an adequate period of anticoagulation therapy, electrical cardioversion (ECV) was planned.

Cover Image  and figure 1 represent ECG before and immediately after ECV, respectively. The patient was not on any therapy other than anticoagulants. Figure 1 depicts ECG of the patient What would be your diagnosis for this case? This image based case is from the Docplexus Editorial Team for educative purposes only.