A patient in their mid-70s presents to the hospital with lightheadedness that came on gradually during brunch with family. She checked her blood pressure and noted her heart rate was in the 30s. She didn’t feel that bad, so she waited a few hours, but it was the same so the family called 911. She denies syncope, palpitations, chest pain, SOB, leg swelling or pain, fever, cough or other complaints. She recently started Eliquis, metoprolol, and Pacerone for atrial flutter.
Vital signs are normal except for a pulse in the 30s. The physical exam is otherwise normal.
An ECG is Done:
What is the most likely rhythm in this patient?