Figure 4: There are 3 separate recordings in the emergency department. Top: There is atrial fibrillation with an average rate at 140 bpm. The patient is awake an alert. Middle: There is atrial fibrillation that terminates with a resultant 4-second pause and near syncope. There is a single sinus beat then the return of atrial fibrillation with a rapid ventricular response. Bottom: There is another symptomatic episode when atrial fibrillation terminates with a resultant 4.4-second pause followed by a single sinus beat then recurrent atrial fibrillation and a rapid ventricular response.