Interesting case of dual tachycardia in a patient with surgical closure of atrial septal defect.

A 34-year-old gentleman, who had undergone pericardial patch closure of ostium secundum atrial septal defect (ASD) at 8 years of age, was evaluated for shortness of breath. Electrocardiogram revealed typical atrial flutter with varying atrioventricular conduction. Echocardiogram showed no residual ASD or pulmonary hypertension and good biventricular function. He was taken for an electrophysiological study with the intention of radiofrequency ablation of the typical flutter.