Palpitations after a MAZE Procedure

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Author(s) A.A.M. Wilde, H.H.D. Idzerda
NHJ edition: 2005:02,72
These Rhythm Puzzles have been published in the Netherlands Heart Journal and are reproduced here under the prevailing creative commons license with permission from the publisher, Bohn Stafleu Van Loghum.
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Figure 1

A 75-year-old lady presented with palpitations. Her medical history reveals cardiac surgery with a mitral valve repair combined with a MAZE procedure two years prior to presentation. In the past two years she had been without complaints. The current palpitations are associated with dizziness, and a general uncomfortable feeling. Upon physical examination blood pressure is normal and the pulse is regular at 190 beats/min. Because of the high rate, the heart sounds could not be interpreted. The ECG at presentation is shown in figure 1. Vagal manoeuvres were not effective nor was adenosine up to a dose of 18 mg.

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