Case Presentation: A 77-year-old female with atrial fibrillation (AF) on flecainide, sinus node dysfunction (SND), and permanent pacemaker presents with frequent palpitations. EKG showed regular, wide-complex tachycardia with ventricular rate of 137 BPM. Device interrogation revealed atrial flutter with 1:1 AV conduction (AL11AV). Rhythm terminated with overdrive atrial pacing along with resolution of symptoms. Troponins [...]