A 67-year-old man with a known dilated cardiomyopathy and a left ventricular ejection fraction of 25% presents to the emergency room with worsening shortness of breath and lightheadedness. His heart rate is 30 bpm and his blood pressure is 90/50 mm Hg. His ECG shows complete heart block with an escape junctional rhythm. As a result of his heart failure and low left ventricular ejection fraction it is decided to use a pacing implantable cardioverter-defibrillator. Post insertion an ECG is obtained (ECG A).
The patient returns for a follow-up device check one week later and an ECG is repeated (ECG B).
What is the diagnosis?
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