Scenario: An 80-year-old man arrived at the emergency department (ED) with general weakness and diffuse chest discomfort. He had undergone a percutaneous coronary intervention (PCI) of a left circumflex artery branch 3 days prior. Echocardiography after PCI showed hypokinesis of the inferoposterior wall. His medical history included hypertension, hyperlipidemia, diabetes mellitus, cerebral ischemic stroke, and coronary artery disease. He had chronic occlusion of the left circumflex artery (stented ~20 years ago). Vital signs on ED arrival: blood pressure, 110/63 mm Hg; heart rate, 45/min; respiratory rate 18/min; and body temperature, 36.9°C. His 0- and 1-hour troponin levels were within the normal limits. His 12-lead electrocardiogram (ECG) recorded upon ED arrival is shown here.

Atrial flutter at a rate of 300/min with a slow ventricular rate of 42/min to 50/min; right bundle branch block.

Atrial flutter (AFL) is an arrhythmia characterized by rapid atrial depolarizations at a rate of ~250/min to...

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