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A 53-year-old man with a bileaflet mitral valve prosthesis and coronary artery bypass grafting presented with severe symptoms of heart failure. His ECG showed a common atrial flutter with 2:1 conduction and a heart rate of about 130 beats/min; there was no sign of acute myocardial ischaemia. Laboratory findings were also negative. A pharmacological conversion of the atrial …
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