A 48-year-old woman with advanced hypertrophic cardiomyopathy and restrictive physiology, several prior episodes of arrhythmia, several previous pulmonary vein ablations, and atypical flutter, underwent a heart transplant with the Shumway technique. On the second day after the transplant, the ECG shown in Figure 1 was recorded. Amiodarone bolus was administered without effect. Finally, electrical cardioversion was performed, after which, the ECG shown in Figure 2 was recorded, without (Figure 2A) and with (Figure 2B) atrial pacing with a temporary epicardial pacemaker.
What do you think was the diagnosis?
- 1.
Cardioversion has not occurred. The patient has atrial flutter with conduction slowed by amiodarone.
- 2.
Nodal escape was present due to sinus dysfunction of the graft, with atrial flutter of the native atrium.
- 3.
Atrial tachycardia with complete atrioventricular block occurred after electrical cardioversion.
- 4.
Sinus dysfunction was present with nodal escape of the graft and dissociated native sinus activity.
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