Unexpected stop to surgery

Clinical scenario

A previously well 50-year-old male banker was evaluated in the pre-admission clinic prior to a hernia repair. The anaesthetist noted an abnormality on his ECG (Figure 1). This was recorded while he was at rest and with no pain.

On further questioning the patient admitted to some recent shortness of breath on exertion especially when going up hills. He recalled he had a normal stress test 10 years ago. An old ECG was not available. He had a long history