Multifocal atrial tachycardia: Difference between revisions
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==Background== | ==Background== | ||
[[File:Multifocal Atrial Tachycardia.svg|thumb|Rhythm strip of multifocal atrial tachycardia.]] | |||
*Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia | *Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia | ||
*Increased automaticity due to causes listed below | *Increased automaticity due to causes listed below | ||
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*[[CHF]] | *[[CHF]] | ||
*[[Sepsis]] | *[[Sepsis]] | ||
*Methylxanthine toxicity / [[Theophylline toxicity]] | *[[Methylxanthine toxicity]] / [[Theophylline toxicity]] | ||
*[[Electrolyte abnormalities]] | *[[Electrolyte abnormalities]] | ||
*Other associations | *Other associations | ||
**Valvular heart disease | **[[Valvular heart disease]] | ||
**[[DM]] | **[[DM]] | ||
**[[Acute renal failure]] | **[[Acute renal failure]] | ||
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**[[Pneumonia]] | **[[Pneumonia]] | ||
**[[Anemia]] | **[[Anemia]] | ||
**[[Digoxin]] | **[[Digoxin toxicity]] | ||
==Clinical Features== | ==Clinical Features== | ||
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*[[Chest pain]] | *[[Chest pain]] | ||
*Presyncope/[[syncope]] | *Presyncope/[[syncope]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
[[File:Multifocal atrial tachycardia - MAT.png|thumb|Multifocal atrial tachycardia]] | |||
*[[ECG]] | *[[ECG]] | ||
**Irregular tachycardia (>100 bpm) | **Irregular tachycardia (>100 bpm) | ||
**At least 3 distinct p wave morphologies | **At least 3 distinct p wave morphologies with different P-R intervals | ||
**No dominant pacemaker site | **No dominant pacemaker site | ||
*BMP, Magnesium | *BMP, Magnesium | ||
Latest revision as of 17:13, 30 July 2025
Background
- Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia
- Increased automaticity due to causes listed below
Causes
- COPD
- CHF
- Sepsis
- Methylxanthine toxicity / Theophylline toxicity
- Electrolyte abnormalities
- Other associations
- Valvular heart disease
- DM
- Acute renal failure
- Postoperative state
- Pulmonary embolism
- Pneumonia
- Anemia
- Digoxin toxicity
Clinical Features
- Palpitations
- Dyspnea
- Chest pain
- Presyncope/syncope
Differential Diagnosis
Narrow-complex tachycardia
- Regular
- AV Node Independent
- Sinus tachycardia
- Atrial tachycardia (uni-focal or multi-focal)
- Atrial fibrillation
- Atrial flutter
- Idiopathic fascicular left ventricular tachycardia
- AV Node Dependent
- AV Node Independent
- Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs, PJCs, PVCs
- Atrial fibrillation
- Atrial flutter with variable conduction
- Digoxin Toxicity
Palpitations
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
- Misc
Evaluation
- ECG
- Irregular tachycardia (>100 bpm)
- At least 3 distinct p wave morphologies with different P-R intervals
- No dominant pacemaker site
- BMP, Magnesium
- Hemoglobin/hematocrit
- Consider infectious disease work up
- Consider ABG/VBG
Management
- Treat underlying cause
- Replace magnesium
- Replace potassium
- Increased AV nodal activity is unlikely to be effective
- Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves
- Can consider beta-blocker or calcium channel blocker in hemodynamically stable patient
- Use beta-blockers cautiously in patients with pulmonary disease
- Cardioversion not definitive
- MAT likely to recur if underlying etiology not addressed
Disposition
- Disposition depends on underlying illness, but often requires admission due to illness severity
- Poor prognostic sign when MAT develops during hospitalization or acute illness
- 60% in-hospital mortality
- Due to illness, not arrhythmia
- Mean survival around 1 year
- 60% in-hospital mortality