Figure 1
A) Baseline twelve lead ECG showing atrial flutter with 2:1 block, occasional premature ventricular contraction and LBBB prior to cardioversion. Black arrows show atrial flutter waves on ECG rhythm strip II. ECG is of low voltage. Diffuse increase in LV wall thickness is seen in parasternal long axis (B), short axis (C) and apical 4 chamber views (D). TTE LV wall thickness - ECG voltage paradox is present.