Clinical History 245

Seventy-four year old gentleman admitted for evaluation of recurrent syncope. His past medical history is notable for hypertrophic obstructive cardiomyopathy and coronary artery disease. He is status post angioplasty to his left anterior descending coronary artery one year priorto this tracing. He also experienced a prior myocardial infarction in the left circumflex coronary artery distribution.
Comment on this ECG ?