View source for Palpitations after a MAZE Procedure

{{NHJ|
|mainauthor= '''A.A.M. Wilde, H.H.D. Idzerda'''
|edition= 2005:02,72
}}
[[Image:Puzzle_20075_2_072_fig1.jpg|Figure 1|thumb]]

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. 

'''What is your diagnosis?'''

[[Puzzle_2007_2_072_Answer|Answer]]