Interesting ECG, pulse irrgular with bradycardia, BP-110/70 mm Hg

65 years old female pt presented with a history of vertigo, chest pain(retrosternal) along with palpitations on and off since 1 day. NOT a known case of any systemic illness, no history of any drug intake, onset insidious, no history of any surgery. Please opine about the ECG and management.

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ECG = 1 SICK SINUS SYNDROME rhythm strip showing atrial pacemaker from 2 sources in rt atrium one from sinus another from somewhere in atrium rythm strip shows = 1st 2 beats from rt atrium in pairs 3 rd ,& 4 th beats also in pairs different in configuration , P R& R R intervals THIS IS FOLLOWED BY SINUS ARREST FOLLOWED BY A NODAL ESCAPE BEAT 2 RBBB RECOMMANDATIONS 1 SERIAL ECG 2 BLOOD TROP I 3 TO WATCH CAD 4 MAY NEED PPM IF SYNCOPAL ATTACK
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Bradycardia, arrhythmia, incomplete RBBB pattern
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Brady arrithymia Incomplete Rbbb
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Sick Sinus Syndrome(SSS)
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sinus rythm sinus arrest
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Sick sinus syndrome
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Sick sinus syndrome
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