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An 86-year-old man was hospitalised for congestive heart failure. He had severe aortic stenosis, had previously undergone implantation of a single-chamber pacemaker and was in permanent atrial fibrillation. ECG at admission showed paced ventricular stimulation and a somewhat atypical left bundle branch block (LBBB) aspect, as well as atrial fibrillation (figure 1A). The night following admission, he suffered an episode of severe paroxysmal nocturnal dyspnoea (O2 desaturation of 75%). …
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