ECG of the Month: Palpitation and Dyspnea After Atrial Flutter Ablation

A 56-year-old man with a history of obesity, type II diabetes mellitus, chronic obstructive pulmonary disease, hyperlipidemia and coronary artery disease and recent cavo-tricuspid isthmus-dependent atrial flutter ablation presents with palpitations and increased dyspnea.

Figure 1

Figure 1

The ECG is suggestive of which of the following:

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