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A 70-year-old woman with previously asymptomatic pre-excitation presented with reduced level of consciousness and profound hypotension. Electrocardiography revealed pre-excited atrial fibrillation (panel A). The patient required urgent DC cardioversion, subsequently undergoing successful ablation of a left posteroseptal epicardial pathway. Three years previously, because of an incidental finding of pre-excitation on routine electrocardiography, exercise testing had been performed. This had demonstrated gradual diminution …
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