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atrial tachycardia
Atrial tachycardia generally occurs secondary to increased automaticity & less frequently to re-entry. Atrial tachycardia with AV block may also occur, generally 2:1 block but may be as much as 4:1 block.
Etiology:
1) coronary artery disease
2) chronic lung disease especially with AV block
3) acute alcohol ingestion
4) digitalis toxicity especially with AV block
5) increased automaticity
6) re-entry
7) electrolyte abnormalities
- hypokalemia especially with AV block
Clinical manifestations:
1) may be difficult to distinguish from atrial flutter
2) may be asymptomatic
3) palpitations
4) dizziness
5) dyspnea
Special laboratory:
- electrocardiogram:
a) atrial rate of 130-200/min
b) p-waves have abnormal configuration & axis
c) isoelectric interval between p-waves
d) PR interval depends upon the atrial rate
e) QRS complex
1] may be normal
2] may show bundle branch block secondary to increased rate
f) 2nd degree AV block associated with digitalis toxicity
Management:
1) correct underlying precipitating factors
2) digitalis toxicity (PAT)
a) discontinue digitalis
b) normalize serum potassium levels
c) symptomatic refractory PAT
- lidocaine
- propranolol
- phenytoin
3) conditions not associated with digitalis
a) Ca+2-channel blockers
b) beta-adrenergic receptor antagonists
c) digitalis
4) cardioversion
a) indication: persistent atrial tachycardia
b) chemical cardioversion with class Ia, Ic or III anti- arrhythmic agents
c) synchronized DC cardioversion (50 joules)
5) radio frequency catheter ablation
a) highly successful
b) condition may recur
6) surgical ablation
7) no benefit for stroke prevention, excess major bleeding with anticoagulation [3]
Related
atrial fibrillation (AF)
atrial flutter
cardiac conduction re-entry
Specific
multifocal (chaotic) atrial tachycardia (MAT)
paroxysmal atrial tachycardia (PAT)
General
supraventricular tachycardia (SVT)
References
- Manual of Medical Therapeutics, 28th ed, Ewald &
McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 141-42
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 272-73
- Kirchhof P et al.
Anticoagulation with edoxaban in patients with atrial high-rate episodes.
N Engl J Med 2023 Aug 25; [e-pub].
PMID: 37622677
https://www.nejm.org/doi/10.1056/NEJMoa2303062