eMedicine Specialties > Cardiology > Arrhythmias

Multifocal Atrial Tachycardia

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

Introduction

Background

Multifocal atrial tachycardia (MAT) is an arrhythmia with an irregular atrial rate greater than 100 beats per minute (bpm). Atrial activity is well organized, with at least 3 morphologically distinct P waves, irregular P-P intervals, and an isoelectric baseline between the P waves. Shine, Kastor and Yurchak first proposed this definition in 1968.1 Multifocal atrial tachycardia has previously been described by names such as chaotic atrial rhythm or tachycardia, chaotic atrial mechanism, and repetitive paroxysmal MAT.

Pathophysiology

The mechanism of the arrhythmia has not been well defined. Delayed afterdepolarizations leading to triggered automaticity are postulated to result in the development of MAT. The evidence that implicates this mechanism is mainly indirect and points to intracellular calcium overload by various mechanisms (eg, catecholamine excess, phosphodiesterase inhibition, acidosis, hypoxemia). Electrolyte imbalances associated with severe underlying illnesses can further potentiate the development of this arrhythmia.

Frequency

United States

MAT is a relatively infrequent arrhythmia, with a prevalence rate of 0.05-0.32% in patients who are hospitalized. The condition is even less common in children and young adults.

Mortality/Morbidity

Patients with MAT frequently have significant comorbidities, especially chronic obstructive pulmonary disease (COPD) and respiratory failure, and are often treated in ICUs. Consequently, a high mortality rate (ie, up to 45%) is associated with this arrhythmia, although it is not a direct consequence of the rhythm abnormality.

Sex

MAT is predominantly observed in males.

Age

MAT is commonly observed in older patients. The average age of patients from 9 studies was 72 years.

Clinical

History

The clinical profile of patients who develop this arrhythmia includes pulmonary, cardiac, metabolic, and endocrinopathic disorders.

  • COPD is the most common underlying disease process (60%). The arrhythmia is commonly precipitated by exacerbation of COPD, sometimes due to infection or cardiac decompensation. Increasing hypoxemia with respiratory acidosis and advanced disease also leads to increased bronchodilator usage, thereby increasing catecholamine levels, which may contribute to development of MAT.
  • Cardiac: Patients with MAT frequently have cardiac diseases, mainly coronary artery disease and valvular heart diseases, often in conjunction with COPD. Congestive heart failure (CHF) is often present when the diagnosis of MAT is first made.
  • Metabolic disorders: In various series, 24% of patients with MAT were found to have diabetes mellitus. Fourteen percent had hypokalemia, and 14% had azotemia.
  • Postoperative: Twenty-eight percent of patients with MAT were recovering from major surgery, while others had postoperative infections, sepsis, pulmonary embolism, and CHF.
  • Pulmonary embolism: The link between pulmonary embolism and MAT is weak (ie, 6-14% of such patients have been said to have MAT), but the methods of diagnosing pulmonary embolism have not been well documented.
  • Intravenous drug abuse: Experimental evidence demonstrates that IV cocaine use may lead to the development of MAT.

Physical

Physical examination of the patient is typically related to findings associated with the underlying disease process and is not specific for MAT. The pulse is rapid and irregular2 , and the first heart sound may be variable. The physical examination is not typically sufficient to differentiate multifocal atrial tachycardia from atrial fibrillation.

Causes

Causes of MAT are mainly related to underlying illnesses.

  • The following common underlying illnesses are associated with this arrhythmia:
    • COPD
    • Coronary artery disease
    • CHF
    • Valvular heart disease
    • Diabetes mellitus
    • Hypokalemia
    • Hypomagnesemia
    • Azotemia
    • Postoperative state
    • Pulmonary embolism

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
[ CLOSE WINDOW ]

References

  1. Shine KI, Kastor JA, Yurchak PM. Multifocal atrial tachycardia. Clinical and electrocardiographic features in 32 patients. N Engl J Med. Aug 15 1968;279(7):344-9. [Medline].

  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].

  11. Arsura EL, Solar M, Lefkin AS. Metoprolol in the treatment of multifocal atrial tachycardia. Crit Care Med. Jun 1987;15(6):591-4. [Medline].

  12. Hazard PB, Burnett CR. Treatment of multifocal atrial tachycardia with metoprolol. Crit Care Med. Jan 1987;15(1):20-5. [Medline].

  13. Cohen L, Kitzes R, Shnaider H. Multifocal atrial tachycardia responsive to parenteral magnesium. Magnes Res. Dec 1988;1(3-4):239-42. [Medline].

  14. Iseri LT, Fairshter RD, Hardemann JL, Brodsky MA. Magnesium and potassium therapy in multifocal atrial tachycardia. Am Heart J. Oct 1985;110(4):789-94. [Medline].

  15. McCord JK, Borzak S, Davis T, Gheorghiade M. Usefulness of intravenous magnesium for multifocal atrial tachycardia in patients with chronic obstructive pulmonary disease. Am J Cardiol. Jan 1 1998;81(1):91-3. [Medline].

  16. Ho KM. Intravenous magnesium for cardiac arrhythmias: jack of all trades. Magnes Res. Mar 2008;21(1):65-8. [Medline].

  17. Kouvaras G, Cokkinos DV, Halal G, et al. The effective treatment of multifocal atrial tachycardia with amiodarone. Jpn Heart J. May 1989;30(3):301-12. [Medline].

  18. Kuralay E, Cingoz F, Kilic S, et al. Supraventricular tachyarrythmia prophylaxis after coronary artery surgery in chronic obstructive pulmonary disease patients (early amiodarone prophylaxis trial). Eur J Cardiothorac Surg. Feb 2004;25(2):224-30. [Medline].

  19. Hsieh MY, Lee PC, Hwang B, Meng CC. Multifocal atrial tachycardia in 2 children. J Chin Med Assoc. Sep/2006;69:439-43. [Medline]. [Full Text].

  20. Pierce WJ, McGroary K. Multifocal atrial tachycardia and Ibutilide. Am J Geriatr Cardiol. Jul-Aug 2001;10(4):193-5. [Medline].

  21. Barranco F, Sanchez M, Rodriguez J, Guerrero M. Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency. Intensive Care Med. 1994;20(1):42-4. [Medline].

  22. Tucker KJ, Law J, Rodriques MJ. Treatment of refractory recurrent multifocal atrial tachycardia with atrioventricular junction ablation and permanent pacing. J Invasive Cardiol. Sep 1995;7(7):207-12. [Medline].

  23. Berlinerblau R, Feder W. Chaotic atrial rhythm. J Electrocardiol. 1972;5(2):135-44. [Medline].

  24. Bisset GS, Seigel SF, Gaum WE, Kaplan S. Chaotic atrial tachycardia in childhood. Am Heart J. Mar 1981;101(3):268-72. [Medline].

  25. Cohen TJ. Skinning an old ailment (multifocal atrial tachycardia) with a new treatment (radiofrequency catheter ablation). J Invasive Cardiol. Sep 1995;7(7):213. [Medline].

  26. Habibzadeh MA. Multifocal atrial tachycardia: a 66 month follow-up of 50 patients. Heart Lung. Mar-Apr 1980;9(2):328-35. [Medline].

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

  28. Lipson MJ, Naimi S. Multifocal atrial tachycardia (chaotic atrial tachycardia). Clinical associations and significance. Circulation. Sep 1970;42(3):397-407. [Medline].

  29. McCord J, Borzak S. Multifocal atrial tachycardia. Chest. Jan 1998;113(1):203-9. [Medline].

  30. Mehta A, Jain AC, Mehta MC. Electrocardiographic effects of intravenous cocaine: an experimental study in a canine model. J Cardiovasc Pharmacol. Jan 2003;41(1):25-30. [Medline].

[ CLOSE WINDOW ]

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

[ CLOSE WINDOW ]

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.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.