Case 46

Abstract

A 79-year-old male with a history of hypertension, coronary artery bypass grafting, and implantable cardioverter-defibrillator for ventricular fibrillation, presented with symptomatic supraventricular tachycardia. He had failed antiarrhythmic medications and cardioversion attempts, and was referred for electrophysiology study and catheter ablation. Twelve-lead electrocardiogram showed organized atrial activity with positive flutter waves in lead V1 and inferior leads, not suggestive of typical counterclockwise atrial flutter (Fig. 46.1). © Springer-Verlag London Limited 2011.