Abstract: In this study, the intraoperative cardiac arrest in a patient with long-term atrial tachycardia during radiofrequency ablation were observed, and the patient was performed the right atrial matrix mapping under the guidance of a three-dimensional mapping system and implemented the dual chamber pacemaker implantation. Under the guidance of the three-dimensional mapping system, large areas of low voltage and scarring were found on the free wall and anterior wall of the right atrium on the mapping side. During pacemaker implantation, the right atrial electrode was adjusted by multiple times, but the pacing threshold parameters were not ideal, resulting in the failure of the right atrial electrode implantation. Long-term atrial tachycardia may lead to atrial electrical remodeling and atrial fibrosis, thereby causing failure of right atrial electrode implantation.