History:

A patient in their late 80s presents to the urgent care with 2 episodes of near syncope each day for the past 3 days. The episodes are not triggered by activity, standing, or anything else he can identify. He denies palpitations, chest pain, SOB, leg swelling or pain, fever, cough, or other complaints.

Exam:

Vital signs are normal. The physical exam is also normal.

An ECG is done:

Credit: Brady Pregerson, MD

What is the most likely cause of the ECG findings in this patient?