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Pneumoperitoneum associated with carbon dioxide (CO2) insufflation may induce alterations in electrocardiographic variables, which may produce severe atrial and ventricular arrhythmias. We now present a case in which atrial flutter developed after CO2 insufflation in a patient undergoing laparoscopic subtotal gastrectomy. Although the ECG change was reversed after desufflation, one should keep in mind the increased propensity to atrial and ventricular arrhythmias during laparoscopy with high intra-abdominal pressure.