Multifocal atrial tachycardia

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  • Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia
  • Increased automaticity due to causes listed below


Clinical Features

  • Palpitations
  • Dyspnea
  • Chest pain
  • Presyncope/syncope
Multifocal atrial tachycardia

Differential Diagnosis



  • ECG
  • Irregular tachycardia (>100 bpm)
  • At least 3 distinct p wave morphologies
  • No dominant pacemaker site
  • BMP
  • Magnesium level
  • Hb/Hct


  • Treat the 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 BB/CCB in hemodynamically stable patient (caution with pulmonary disease)
  • Cardioversion not definitive, likely recurrence if underlying illness not addressed


  • 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