A 73-year-old man with a history of paroxysmal atrial fibrillation who was being treated with a β-blocker and digoxin presents to the emergency room after 2 days of nausea, vomiting, and abdominal pain. He is placed on telemetry because of a slightly irregular heart rate. It is thought that he has a viral gastroenteritis. Noted on telemetry are several pauses in the rhythm; hence, a 12-lead ECG is obtained.
What is the diagnosis?
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