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A 51-year-old man was referred to our electrophysiology service with symptomatic paroxysmal atrial fibrillation (AF) and frequent asymptomatic ventricular ectopic beats originating from the right ventricular outflow tract. The patient had longstanding gastro-oesophageal reflux symptoms and was previously diagnosed with a hiatus hernia. Flecainide 50 mg twice daily had been commenced but symptoms persisted therefore flecainide was increased to 100 mg twice daily and bisoprolol 1.25 mg was added. A cardiac MRI scan was requested to investigate the possibility of arrhythmogenic right ventricular cardiomyopathy as the cause of the ventricular ectopic beats and to assess left …
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