Overview of cardiac arrhythmias (Cardiac arrhythmias) practice

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A 72-year-old woman with severe chronic obstructive pulmonary disease is admitted with worsening breathlessness. Her pulse is irregular at 118 beats per minute. The ECG shows narrow QRS complexes, at least three different P-wave shapes, varying P-P intervals and an isoelectric baseline between P waves; the PR intervals also vary. Which one of the following is the most likely diagnosis?