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A 28-year-old man was admitted because of high-rate atrial fibrillation (panel A). He had recurrent episodes of paroxysmal atrial fibrillation despite β-blocker, flecainide, propafenone, and amiodarone administration. Two-dimensional echocardiography showed normal parameters, whereas tissue Doppler imaging registered reduced relaxation and contraction velocities suggesting myocardial abnormalities. Cardiac magnetic resonance imaging failed to show areas of thickened or dysfunctional cardiac wall and late-enhancement signals after gadolinium infusion. Owing to drug resistance of …
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