Difference between revisions of "Multifocal atrial tachycardia"

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*Increased AV nodal activity is unlikely to be effective
 
*Increased AV nodal activity is unlikely to be effective
 
**Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves
 
**Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves
**Cardioversion not definitive, likely recurrence if underlying illness not addressed
+
**Can consider BB/CCB in hemodynamically stable patient (caution with pulmonary disease)
 +
*Cardioversion not definitive, likely recurrence if underlying illness not addressed
  
 
==Disposition==
 
==Disposition==

Revision as of 20:56, 28 April 2015

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
  • Electrolyte abnormalities

Clinical Features

Multifocal atrial tachycardia

Differential Diagnosis

Palpitations

Workup

  • ECG
  • Irregular tachycardia (>100 bpm)
  • At least 3 distinct p wave morphologies
  • No dominant pacemaker site

Management

  • Treat the underlying cause
  • Increased AV nodal activity is unlikely to be effective
    • Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves
    • Can consider BB/CCB in hemodynamically stable patient (caution with pulmonary disease)
  • Cardioversion not definitive, likely recurrence if underlying illness not addressed

Disposition

  • Disposition depends on the underlying illness, but often requires admission due to illness severity/age
  • Poor prognostic sign when developed during hospitalization/illness
    • 60% in hospital mortality
    • mean survival around 1 year
    • Due to illness not arrhythmia

See Also

External Links

Sources