Scenario: A 65-year-old man with a history of hypertension and hypercholesterolemia underwent an aortic valve repair (AVR). He had no prior history of atrial or ventricular arrhythmias, and his preoperative electrocardiogram (ECG) demonstrated normal sinus rhythm (NSR). The surgery and subsequent 22-hour stay in the intensive care unit were unremarkable. He was then transferred to the cardiac step-down unit, where he was hemodynamically stable with a heart rate of 72/min in NSR. Approximately 3 hours after transfer, the patient developed palpitations and shortness of breath. Bedside telemetry and a 12-lead ECG confirmed new-onset postoperative atrial flutter (AF) with rapid ventricular response. Results of a basic metabolic panel were within normal limits, and a transthoracic echocardiogram showed a well-functioning AVR with preserved left ventricular function and no significant structural abnormalities. Intravenous amiodarone and heparin infusions were started. Approximately 18 hours after the amiodarone infusion was initiated, a telemetry alarm for...

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