Sinus rhythm with sinus arrhythmia. Left atrial abnormality. Evidence of intermittent pre-excitation (right anterior accessory pathway). The repolarization changes are a consequence of abnormal of activation of the myocardial cells through the accessory pathway (as we see with premature ventricular contractions) and dose not reflect ischemia. We do also notice the disappearance of those findings with normally conducted beats (although if there were any, it would reflect underling LVH despite does not meet voltage criteria). It appears there was a loss of the conduction intermittently through the accessory pathway during faster sinus rate around 100 bpm (middle part of the EKG) which is a good sign indicative of a benign one (hopefully). At the beginning of the EKG, his sinus rate was around 75 bpm. Also, his job is not a high risk one. Given the above, I would not recommend EP study or exercise EKG stress test.