Atrial tachycardia: Difference between revisions
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◼︎ Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often a symptomatic. | ◼︎ Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often a symptomatic. | ||
◼︎ 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 and it is important not to misdiagnose the rhythm as sinus tachycardia in such cases. | ||
◼︎ Focal atrial tachycardia should be treated with urgent electrical cardio version if the patient is unstable. | ◼︎ Focal atrial tachycardia should be treated with urgent electrical cardio version if the patient is unstable. | ||
◼︎ Stable patients may cardiovert with adenosine or with beta blockers. | ◼︎ Stable patients may cardiovert with adenosine or with beta blockers. | ||
◼︎ If digoxin toxicity is the cause of the atrial tachycardia the drug should be stopped. | ◼︎ If digoxin toxicity is the cause of the atrial tachycardia the drug should be stopped. | ||
◼︎ Rate control and or prophylaxis against recurrent episodes can be attained usually with beta blockers, or calcium channel blockers. | ◼︎ Rate control and or prophylaxis against recurrent episodes can be attained usually with beta blockers, or calcium channel blockers. | ||
==External Links== | ==External Links== | ||
Revision as of 20:57, 28 March 2020
Background
- Also known as focal atrial tachycardia
- 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
Clinical Features
- 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
- 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
. 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.
. The atrial (P wave), is usually100-250 /min with abnormally shaped P waves. The combination of focal atrial tachycardia with AV block is particularly common in digoxin toxicity.
. Multifocal atrial tachycardia 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.
Management
◼︎ Non-sustained episodes of focal tachycardia are commonly seen on ambulatory ECG monitoring and are often a symptomatic.
◼︎ 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.
◼︎ Focal atrial tachycardia should be treated with urgent electrical cardio version if the patient is unstable.
◼︎ Stable patients may cardiovert with adenosine or with beta blockers.
◼︎ If digoxin toxicity is the cause of the atrial tachycardia the drug should be stopped.
◼︎ Rate control and or prophylaxis against recurrent episodes can be attained usually with beta blockers, or calcium channel blockers.