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Feeling the squeeze: an unusual cause of atrial fibrillation
  1. Ian P Temple,
  2. Matthias Schmitt,
  3. David J Fox
  1. Department of Cardiology, Northwest Heart Centre, University Hospital South Manchester, Manchester, UK
  1. Correspondence to Dr David J Fox, Department of Cardiology, Northwest Heart Centre, University Hospital South Manchester, Manchester M23 9LT, UK;{at}

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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 …

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  • Contributors IPT: registrar who has written the first draft of the manuscript and edited the images. MS: imaging consultant who has performed both cardiac MRI studies, interpreted the findings, created the figure images/legends and reviewed the final draft of the manuscript. DJF: the electrophysiology consultant who investigated the patient, instigated management with the surgeons, suggested the images for publication and revised the first draft into its final version for submission. DJF is responsible for the overall content as guarantor.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.