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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
- Other associations
Clinical Features
- Palpitations
- Dyspnea
- Chest pain
- Presyncope/syncope
Multifocal atrial tachycardia
Differential Diagnosis
- Arrhythmias:
- Non-arrhythmic cardiac causes:
- Psychiatric causes:
- Drugs and Medications:
- Misc
Workup
- ECG
- Irregular tachycardia (>100 bpm)
- At least 3 distinct p wave morphologies
- No dominant pacemaker site
- BMP
- Magnesium level
- Hb/Hct
Management
- 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
- 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