,IMPRESSION: , Mr. A is a 50-year-old gentleman with a history of paroxysmal atrial fibrillation in the past, more recently is having breakthrough atrial flutter despite flecainide and we had performed a transesophageal echocardiogram-guided cardioversion for him in late 12/20/09, who now has another recurrence within the past 41 hours or so. 
,IMPRESSION : , Mr. A is a 50 - year - old gentleman with a history of paroxysmal atrial fibrillation in the past , more recently is having breakthrough atrial flutter despite flecainide and we had performed a transesophageal echocardiogram - guided cardioversion for him in late 12/20/09 , who now has another recurrence within the past 41 hours or so .