An 81-Year-Old Female with a History of A-Fib and a Recent Syncope Event

The patient is an 81-year-old female with past medical history of atrial fibrillation on apixaban who presents to urgent care after a syncopal episode 30 minutes prior to arrival. The patient felt lightheaded while being pushed in her wheelchair and then lost consciousness. There was no trauma. She returned to baseline approximately 2 minutes after the event. There was no seizure activity. The patient denied associated chest pain, shortness of breath, headache, urinary or fecal incontinence, tongue biting or any other complaints. On evaluation, the patient’s vital signs are normal. She is breathing comfortably and speaking in complete sentences.

View the initial ECG and consider what your diagnosis and next steps would be.