ECG Case #35 - Question #1

A 91 year old male with no significant past medical history presents with generalized weakness and one episode of syncope while he was watching TV. His blood pressure is currently 132/58, heart rate 40, respirations 12, and oxygen saturation 95% on room air. Physical examination reveals cannon A waves in the jugular venous pulsations, heart sounds are bradycardic with varying intensities of the S1 heart sound, no S3 or S4 heard. Labs are all normal. Below is his ECG: