Template:ACLS Narrow Irregular Tachycardia

Narrow Irregular Tachycardia

• Multi-focal atrial tachycardia (MAT)
  • Treat underlying cause (hypokalemia, hypomagnesemia)
  • Consider diltiazem
  • Avoid beta blockers unless they are already known to be tolerated, as airway disease often co-morbid
  • If not symptomatic and rate < 110/120 bpm, may not require treatment (e.g., patient with MAT secondary to COPD)
• Sinus tachycardia with frequent PACs
  • Treat underlying cause
• A fib / A Flutter with variable conduction (see also Atrial Fibrillation with RVR)
  • Check if patient has taken usual rate-control meds
    • If missed dose, may provide dose of home medication and observe for resolution
  • Determine whether patient is better candidate for rate control or rhythm control
    • Rate control preferred with:
      • Persistent A fib
      • Less symptomatic patients
      • Age 65 or older
      • Hypertension
      • No heart failure
      • Previous failure to cardiovert
      • Patient preference
    • Rhythm control preferred with:
      • Paroxysmal or new A fib
      • More symptomatic patients
      • Age < 65 years
      • Heart failure clearly exacerbated by A fib
      • No history of rhythm control failure
      • Patient preference
  • Rate control with:
    • Diltiazem
    • Metoprolol
    • Amiodarone (good in setting of hypotension, CHF)
    • Digoxin (good in setting of CHF)
  • Rhythm conversion with:
    • Synchronized Cardioversion (120-200 J)
      • Best performed on patients with new onset A fib or patients fully therapeutically anti-coagulated for > 3 weeks
    • Procainamide per Ottawa Aggressive ED Cardioversion Protocol