eMedicine Specialties > Cardiology > Arrhythmias

Multifocal Atrial Tachycardia: Differential Diagnoses & Workup

Author: Neeraj Tandon, MB, BS, Chief, Cardiology Section, Associate Professor of Medicine, Medical Service, Overton Brooks Veterans Affairs Medical Center
Coauthor(s): Pratap Reddy, MD, Director, Electrophysiology Service, Professor, Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center
Contributor Information and Disclosures

Updated: May 11, 2009

Differential Diagnoses

Atrial Fibrillation
Atrial Flutter

Other Problems to Be Considered

Sinus tachycardia with frequent premature atrial contractions (PACs)

Workup

Laboratory Studies

  • Laboratory testing mainly consists of an assessment of serum chemistry level, blood hemoglobin level, and arterial blood gas levels.
    • Serum chemistry level - To exclude electrolyte disorders
    • Blood hemoglobin level and RBC counts - To seek evidence of anemia
    • Arterial blood gas level - To define pulmonary status
  • Further testing depends on the etiology of the underlying disease process.

Imaging Studies

  • Chest radiograph - To define pulmonary status
  • The diagnosis of multifocal atrial tachycardia (MAT) is confirmed with an ECG meeting the following criteria:
    • Irregular ventricular rate greater than 100 bpm
    • Organized and discrete P waves with at least 3 different morphologies in the same electrocardiographic lead
    • Irregular PP, PR, and RR intervals with an isoelectric baseline between the P waves
    • Some authors have suggested that patients who have rhythms with a rate less than 100 bpm but who satisfy all other criteria (including the clinical profile commonly observed with MAT) be considered to have cases of multifocal atrial rhythm and multifocal atrial bradycardia, when the rate is less than 60 bpm.
      • However, a controversy arises about whether this condition should be referred to as a MAT variant or a wandering atrial pacemaker. Patients with wandering atrial pacemaker usually do not have serious underlying illnesses.
      • The requirement that 3 different P waves should exist has been applied since early descriptions of the arrhythmia were recorded, but whether this should be interpreted as 2 ectopic P waves and 1 sinus P wave or 3 ectopic P waves has been a matter of controversy.
      • The consensus favors a minimum of 3 different waveforms in addition to sinus P waves.
  • Baseline noise on the ECG can mimic atrial fibrillation, and obscure differences in P wave morphology. Conversely, coarse atrial fibrillation on short recordings may appear to show discrete P waves prior to each QRS complex. Longer ECG recordings are therefore useful.

More on Multifocal Atrial Tachycardia

Overview: Multifocal Atrial Tachycardia
Differential Diagnoses & Workup: Multifocal Atrial Tachycardia
Treatment & Medication: Multifocal Atrial Tachycardia
Follow-up: Multifocal Atrial Tachycardia
Multimedia: Multifocal Atrial Tachycardia
References
Further Reading
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References

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  2. Esperer HD, Esperer C, Cohen RJ. Cardiac arrhythmias imprint specific signatures on Lorenz plots. Ann Noninvasive Electrocardiol. Jan 2008;13(1):44-60. [Medline].

  3. Adcock JT, Heiselman DE, Hulisz DT. Continuous infusion diltiazem hydrochloride for treatment of multifocal atrial tachycardia (abstract). Clin Res. 1994;42:430A.

  4. Aronow WS, Plasencia G, Wong R. Effect of verapamil versus placebo on PAT and MAT. Current Ther Res. 1980;27:823-29.

  5. Hazard PB, Burnett CR. Verapamil in multifocal atrial tachycardia. Hemodynamic and respiratory changes. Chest. Jan 1987;91(1):68-70. [Medline].

  6. Kastor JA. Multifocal atrial tachycardia. N Engl J Med. Jun 14 1990;322(24):1713-7. [Medline].

  7. Levine JH, Michael JR, Guarnieri T. Treatment of multifocal atrial tachycardia with verapamil. N Engl J Med. Jan 3 1985;312(1):21-5. [Medline].

  8. Parillo JE. Treating Multifocal Atrial Tachycardia (MAT) in a critical care unit: new data regarding verapamil and metoprolol. Update Crit Care Med. 1987;2:3-5.

  9. Salerno DM, Anderson B, Sharkey PJ, Iber C. Intravenous verapamil for treatment of multifocal atrial tachycardia with and without calcium pretreatment. Ann Intern Med. Nov 1987;107(5):623-8. [Medline].

  10. Arsura E, Lefkin AS, Scher DL, et al. A randomized, double-blind, placebo-controlled study of verapamil and metoprolol in treatment of multifocal atrial tachycardia. Am J Med. Oct 1988;85(4):519-24. [Medline].

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  27. Levine JH, Michael JR, Guarnieri T. Multifocal atrial tachycardia: a toxic effect of theophylline. Lancet. Jan 5 1985;1(8419):12-4. [Medline].

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Keywords

MAT, chaotic atrial rhythm, chaotic atrial tachycardia, chaotic atrial mechanism, repetitive paroxysmal multifocal atrial tachycardia, intracellular calcium overload, catecholamine excess, phosphodiesterase inhibition, acidosis, hypoxemia, electrolyte imbalances associated with severe underlying illnesses, COPD, congestive heart failure, metabolic disorders, diabetes mellitus, hypokalemia, azotemia, postoperative infections, sepsis, pulmonary embolism, respiratory acidosis, coronary artery disease, valvular heart disease, hypomagnesemia, azotemia, multifocal atrial rhythm, multifocal atrial bradycardia, wandering atrial pacemaker

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Contributor Information and Disclosures

Author

Neeraj Tandon, MB, BS, Chief, Cardiology Section, Associate Professor of Medicine, Medical Service, Overton Brooks Veterans Affairs Medical Center
Neeraj Tandon, MB, BS is a member of the following medical societies: American College of Cardiology and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Coauthor(s)

Pratap Reddy, MD, Director, Electrophysiology Service, Professor, Department of Medicine, Section of Cardiology, Louisiana State University Health Sciences Center
Pratap Reddy, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, American Federation for Medical Research, American Heart Association, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Alan D Forker, MD, Professor of Medicine, Program Director of Cardiovascular Fellowship, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research Center, MidAmerica Heart Institute of St Luke's Hospital
Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa
Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Frank M Sheridan, MD, Cardiology, Providence Everett Medical Center
Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD, Professor of Medicine and Pharmacology, Director, Clinical Cardiac Electrophysiology Fellowship Program, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center
Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)
Disclosure: Nothing to disclose.

 
 
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