Atrial tachycardia: Difference between revisions
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==Background==
==Background==
*Also known as focal atrial tachycardia, Paroxysmal Atrial Tachycardia (PAT), unifocal atrial tachycardia, ectopic atrial tachycardia
*Also known as focal atrial tachycardia, Paroxysmal Atrial Tachycardia (PAT), unifocal atrial tachycardia, ectopic atrial tachycardia<ref>Patel A, Markowitz SM. Atrial tachycardia: mechanisms and management. Expert Rev Cardiovasc Ther. 2008 Jul;6(6):811-22. PMID 18570619</ref>
*Rate >100 bpm
*Rate >100 bpm
*Electrical focus that originates outside in the sinus node at a single location
*Electrical focus that originates outside in the sinus node at a single location
**By comparison, reentrant tachycardias (eg. AVRT, AVNRT) involve multiple foci/ larger circuits
**By comparison, reentrant tachycardias (eg. [[Paroxysmal supraventricular tachycardia|AVRT, AVNRT]]) involve multiple foci/ larger circuits
*Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy and it is important not to misdiagnose the rhythm as [[sinus tachycardia]] in such cases.
*Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy.
*Atrial tachycardia differs from sinus tachycardia in that the impulses are generated by an ectopic focus somewhere within the atrial myocardium rather than the sinus node.  
*Differs from sinus tachycardia in that the impulses are generated by an ectopic focus somewhere within the atrial myocardium rather than the sinus node.  
*The atrial (P wave), is usually 100-250 /min with abnormally shaped P waves. The combination of focal atrial tachycardia with AV block is particularly common in digoxin toxicity.
*Multifocal atrial tachycardia is similar, but has P waves with at least three different morphologies.
*Multifocal atrial tachycardia can be mistaken for AF, due to its irregular nature, but closer inspection of the ECG will reveal P waves with at least three different morphologies.
*The combination of atrial tachycardia plus AV block is particularly common in [[digoxin toxicity]].


==Clinical Features==
==Clinical Features==
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====ECG Features====
====ECG Features====
*Atrial rate >100 bpm
*Atrial rate >100 bpm
*P wave morphology abnormal (when compared with sinus P wave due to ectopic origin)
*P-waves
*P-wave axis frequently abnormal (e.g. inverted in inferior leads)
**Morphology abnormal (when compared with sinus P wave due to ectopic origin)
*At least three consecutive identical ectopic p waves
**Has at least three consecutive identical ectopic p waves
*QRS complexes usually normal morphology (unless pre-existing bundle branch block, accessory pathway, or rate related aberrant conduction)
**Axis frequently abnormal (e.g. inverted in inferior leads)
*Isoelectric baseline (unlike atrial flutter)
*QRS complexes
**Usually normal morphology (unless pre-existing bundle branch block, accessory pathway, or rate related aberrant conduction)
*Baseline isoelectric (unlike atrial flutter)
*[[AV block]] may be present
*[[AV block]] may be present


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===Stable===
===Stable===
*May cardiovert with [[adenosine]] or with [[beta blockers]]
''Initial treatment may be aimed at rate control, while later resolution of clinical symptoms usually requires restoration of normal sinus rhythm.''
*If [[digoxin toxicity]], stop drug and consider [[Digibind]]
*If [[digoxin toxicity]], stop drug and consider [[Digoxin Immune Fab]]
*[[Beta blocker]] or [[calcium channel blocker]] for rate control and/or prophylaxis against recurrent episodes
*[[Beta-blockers]] are first-line, particularly if blood pressure is stable
*Other options include:
**[[Calcium channel blocker]]
**[[Digoxin]]
**[[Amiodarone]]
 
==Disposition==


==See Also==
==See Also==
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==External Links==
==External Links==
*https://litfl.com/atrial-tachycardia-ecg-library/
*[https://litfl.com/atrial-tachycardia-ecg-library/ LITFL - Focal Atrial Tachycardia (FAT)]


==References==
==References==
<references/>
<references/>
[[Category:Cardiology]]
[[Category:Cardiology]]

Latest revision as of 11:00, 22 March 2026

Background

  • Also known as focal atrial tachycardia, Paroxysmal Atrial Tachycardia (PAT), unifocal atrial tachycardia, ectopic atrial tachycardia[1]
  • Rate >100 bpm
  • Electrical focus that originates outside in the sinus node at a single location
    • By comparison, reentrant tachycardias (eg. AVRT, AVNRT) involve multiple foci/ larger circuits
  • Sustained atrial tachycardia can lead to a tachycardia-induced cardiomyopathy.
  • Differs from sinus tachycardia in that the impulses are generated by an ectopic focus somewhere within the atrial myocardium rather than the sinus node.
  • Multifocal atrial tachycardia is similar, but has P waves with at least three different morphologies.
  • The combination of atrial tachycardia plus AV block is particularly common in digoxin toxicity.

Clinical Features

  • Often asymptomatic
  • Palpitations
    • Non-specific finding
    • Associated with all tachydysrhythmias, not just AT
    • Rapid fluttering/throbbing/pounding sensation in the chest or neck
  • Syncope
    • Patients with AT rarely present with syncope
    • Cerebral hypoperfusion is more common with a ventricular rate >200 bpm
  • Chest pain
    • Can present if there is underlying cardiovascular disease
    • Represents a worsening of the associated disease
  • Dyspnea
    • Can present if there is underlying cardiovascular disease
    • Represents a worsening of the associated disease

Differential Diagnosis

Narrow-complex tachycardia

Evaluation

P waves inverted in lead II and AVL while upright in III and AVF, suggesting ectopic atrial tachycardia, most likely originating from the left side.

Workup

Diagnosis

ECG Features

  • Atrial rate >100 bpm
  • P-waves
    • Morphology abnormal (when compared with sinus P wave due to ectopic origin)
    • Has at least three consecutive identical ectopic p waves
    • Axis frequently abnormal (e.g. inverted in inferior leads)
  • QRS complexes
    • Usually normal morphology (unless pre-existing bundle branch block, accessory pathway, or rate related aberrant conduction)
  • Baseline isoelectric (unlike atrial flutter)
  • AV block may be present

Management

Unstable

Stable

Initial treatment may be aimed at rate control, while later resolution of clinical symptoms usually requires restoration of normal sinus rhythm.

Disposition

See Also

External Links

References

  1. ↑ Patel A, Markowitz SM. Atrial tachycardia: mechanisms and management. Expert Rev Cardiovasc Ther. 2008 Jul;6(6):811-22. PMID 18570619
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