Figure 2 is a continuous strip from a Holter tracing (lead II). He was interested in catheter ablation due to intolerance of medications, and was referred to our facility.įigure 1 is a 12-lead ECG demonstrating bursts of atrial tachycardia. This study noted “disorganized atrial activity with earliest activation in the left atrium consistent with atrial fibrillation/flutter.” Given the left sided location, the treating physicians decided to pursue medical management with beta blockers and a class Ic antiarrhythmic. He underwent electrophysiologic study at an outside institution. The patient did not demonstrate signs or symptoms of heart failure, and regularly exercised. Further diagnostic testing included a 2D echocardiogram demonstrating evidence of globally depressed left ventricular (LV) function with an ejection fraction (EF) of 33%. Prior Holter monitoring demonstrated episodes of atrial fibrillation as well as an atrial tachycardia.
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