The patient had multiple ED visits with syncopal episodes which I do agree might not be related.

Echo was done at outside facility and reported normal LVEF 63% with moderate left ventricular dilation.

Also, just completed 2 weeks event monitor at outside facility pending report.

I saw the case this Friday and noted the above rhythm during tilt table test.

My assumption was related to non sustained runs of fascicular tachycardia (although they were irregular). Initial beat has rbbb/LPFB morphology and subsequent beats have rbbb/LAFB morphology).

I did prescribe verapamil and referral to EP to consider ablation procedure.

I will keep you posted