Pediatric Atrial Ectopic Tachycardia Differential Diagnoses

  • Author: Shubhayan Sanatani, MD; Chief Editor: Stuart Berger, MD   more...
 
Updated: Mar 29, 2011
 
 

Diagnostic Considerations

The differential diagnosis for a narrow complex tachycardia is extensive, and the term supraventricular tachycardia (SVT) is nonspecific. Differentiation of automatic versus reentrant mechanisms may be determined by the presence of a warm-up or cool-down period at onset and termination and by the response to vagal maneuvers or adenosine.

Go to Atrial Tachycardia and Multifocal Atrial Tachycardia for information on these topics.

A right-sided atrial ectopic tachycardia (AET) focus in the presence of tachycardia-induced cardiomyopathy must be differentiated from idiopathic dilated cardiomyopathy with a secondary compensatory sinus tachycardia; the degree of dysfunction and heart rate are higher and second-degree atrioventricular (AV) block is more common in patients with atrial ectopic tachycardia.

Atrial ectopic tachycardia must also be differentiated from atypical AV node reentry, permanent junctional reciprocating tachycardia, and inappropriate sinus tachycardia. The former 2 usually respond to adenosine with abrupt termination.

Inappropriate sinus tachycardia typically occurs in association with exercise intolerance and a mild elevation of a sinus rate, more commonly in females. Approximately half the patients with atrial ectopic tachycardia demonstrate transient atrial slowing with adenosine, whereas the others demonstrate only transient AV block. Aberrantly conducting atrial ectopic tachycardia must be differentiated from ventricular tachycardia (VT).

In atrial ectopic tachycardia, a conduction delay from atrium to ventricle often occurs. Most patients demonstrate first-degree AV block and some show second-degree block.

Atrial flutter is another included in the differential diagnosis of atrial ectopic tachycardia.

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Contributor Information and Disclosures
Author

Shubhayan Sanatani, MD  Associate Professor, Department of Pediatrics, University of British Columbia Faculty of Medicine; Consulting Staff, Division of Pediatric Cardiology, British Columbia Children's Hospital, Canada

Shubhayan Sanatani, MD is a member of the following medical societies: British Columbia Medical Association, Canadian Cardiovascular Society, Canadian Heart Rhythm Society, Canadian Heart Rhythm Society, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Murray Hamilton, MD, MSc, FRCPC  Section Head, Electrophysiology, Director, High-Risk Hereditary Heart Conditions Clinic, Labatt Family Heart Centre; Professor, Department of Pediatrics, Associate Scientist, Physiology and Experimental Medicine, The Hospital for Sick Children and Research Institute, University of Toronto Faculty of Medicine, Canada

Robert Murray Hamilton, MD, MSc, FRCPC is a member of the following medical societies: American Heart Association, Canadian Cardiovascular Society, Canadian Medical Association, Canadian Medical Protective Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Ontario Medical Association, Pediatric Electrophysiology Society, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Charles I Berul, MD  Professor of Pediatrics and Integrative Systems Biology, George Washington University School of Medicine; Chief, Division of Cardiology, Children's National Medical Center

Charles I Berul, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, Cardiac Electrophysiology Society, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, and Society for Pediatric Research

Disclosure: Johnson & Johnson Consulting fee Consulting

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Hugh D Allen, MD  Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

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  6. Higa S, Tai CT, Lin YJ, et al. Focal atrial tachycardia: new insight from noncontact mapping and catheter ablation. Circulation. Jan 6 2004;109(1):84-91. [Medline]. [Full Text].

  7. Liew R, Catanchin A, Behr ER, Ward D. Use of non-contact mapping in the treatment of right atrial tachycardias in patients with and without congenital heart disease. Europace. Aug 2008;10(8):972-81. [Medline].

  8. Cummings RM, Mahle WT, Strieper MJ, Campbell RM, Costello L, Balfour V. Outcomes following electroanatomic mapping and ablation for the treatment of ectopic atrial tachycardia in the pediatric population. Pediatr Cardiol. Mar 2008;29(2):393-7. [Medline].

  9. Haas NA, Fox S, Skinner JR. Successful use of an intravenous infusion of flecainide and amiodarone for a refractory combination of postoperative junctional and ectopic tachycardias. Cardiol Young. Aug 2005;15(4):427-30. [Medline].

 
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