A 68-Year-Old Man with a History of Permanent Atrial Fibrillation

question 26

Multiple Choice

A 68-year-old man with a history of permanent atrial fibrillation comes to the office for follow-up.  He has been having symptoms due to ineffective ventricular rate control despite aggressive medical therapy.  On examination, the patient's heart rate is 125/min and irregular.  ECG shows atrial fibrillation with rapid ventricular response.  A catheter-based radiofrequency ablation of the atrioventricular node with placement of a permanent ventricular pacemaker is planned.  The ablation tip should be positioned at which of the following locations?

• A)Between the tricuspid valve and the inferior vena cava opening
• B)Interatrial septum near the opening of the coronary sinus
• C)Left atrium near the opening of the pulmonary veins
• D)The posterior border of the fossa ovalis
• E)Upper part of crista terminalis near the superior vena cava opening

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Definitions:

Pope Leo X

was head of the Catholic Church from 1513 to 1521, known for his lavish spending and involvement in the sale of indulgences, which contributed to the Protestant Reformation.

Man of Learning

An individual known for their extensive knowledge or scholarly attainments, often in a specific field.

Head of State

The individual who serves as the chief public representative of a nation, often embodying its sovereignty and executing its laws and policies.

Impasto

A layer of thickly applied pigment.