ECG Sinus node dysfunction

A 52 year old male known case of hypertension come to JIPMER, Pondicherry, India emergency department  with chief complaint of giddiness since last five days but there was no history of syncope. During evaluation in the emergency department patient pulse rate was 44 beats per minute, BP-110/90 mmhg, CVS was normal, Respiratory system was normal. ECG of the patient done in emergency department is shown  below

ECG 1

Sinus bradycardia, heart rate around 50 beats per minute, Sinus rate 28 beats per minute, PR interval 200 msec, narrow QRS, long sinus pause present measuring around 2 sec, junctional escape beat present with narrow QRS morphology with retrograde P wave which are merged with junctional QRS complex, QT interval 400 msec, QTc-273 msec, there were no ST-T wave changes so the ecg is showing escape-capture-escape phenomenon.

ECG 2

Diagnosis- Sinus arrest with symptomatic sinus bradycardia.