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A 71 year old woman presented with severe shortness of breath (New York Heart Association (NYHA) functional class IV) despite optimised medical treatment (angiotensin converting enzyme inhibitor, β blocker, spironolactone, and digoxin). ECG revealed first degree atrioventricular (AV) block (PR interval 256 ms) and left bundle branch block (QRS duration 190 ms). Two dimensional echocardiography showed severe …