Multifocal atrial tachycardia

Background

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

Causes

Clinical Features

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

Differential Diagnosis

Palpitations

Evaluation

  • ECG
    • Irregular tachycardia (>100 bpm)
    • At least 3 distinct p wave morphologies
    • No dominant pacemaker site
  • BMP, Magnesium
  • hemoglobin/hematocrit
  • Consider infectious disease work up
  • Consider ABG/VBG

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

References