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An electrocardiogram showed atrial fibrillation, low voltage in limb leads, and poor R-wave progression in leads V1–V2 at the initial evaluation (A). The low voltage in limb leads progressed and T inversion in leads V3–V6 appeared 8 months later (B). A transthoracic echocardiogram showed left ventricular hypertrophy and severe biatrial dilatation (C, D).
