ECG Case 169

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ECG Case 169

A 24-year-old man presents to his primary physician with complaints of intermittent palpitations. He has noted these symptoms on and off for a year. They occur and remit spontaneously and can last for minutes up to an hour at a time. He denies syncope. He is otherwise healthy and a general review of symptoms is unremarkable. The physician obtains an ECG.

What abnormalities are noted ?