Heart blocks Quiz: Ace Your Exams

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A 20-year-old male college student comes to the clinic with an ECG obtained at a health fair, where he was told the reading was abnormal. He is a competitive track and field athlete and excels in long-distance running. He denies chest pain, shortness of breath, or loss of consciousness. He has no prior medical history and takes no medications other than a daily multivitamin. He denies family history of sudden unexpected deaths. His temperature is 37.0°C (98.6°F), pulse is 65/min, respirations are 20/min, and blood pressure is 115/75 mmHg. He appears thin and comfortable. Physical exam shows a normal heart rate without murmurs and 2+ regular carotid and radial pulses bilaterally. Lungs are clear. ECG shows the following:
A close-up view of an electrocardiogram printout, showing two rows of heart rhythm tracings against a grid paper background. V2 and V3 leads are visible.

Reproduced from: WIkipedia

Which of the following is the most likely etiology of this patient’s ECG finding?

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