Fig. 4

Images of Case 2 (III-1). a Case 2 developed complete atrioventricular block in his forties. b Five years after implantation of a pacemaker, he was admitted to hospital due to ventricular tachycardia. c On admission, electrocardiogram showed pacing rhythm, a heart rate of 60 ppm, and a QTc interval of 480 msec. d Chest X-ray revealed no congestion or pleural effusion, and a cardiothoracic ratio of 48.5% with a pacemaker. e Echocardiogram showed a reduced left ventricular ejection fraction of 33.2%, a large left ventricular diastolic diameter of 54.1 mm, and a left atrial diameter of 35.6 mm