ECG of the Week - 20th May 2013

This ECG is from a 64 year old male. 
Presented following multiple episodes of syncope.

Click to enlarge

VAQ Corner

A 64 year old male presents to your ED following an episode of syncope.
He complains of feeling lighted. 
BP 105/60 RR 18 Sats 96% Room Air

a) Describe & interpret his ECG (50%)
b) Outline your management (50%)