Atrial Tachycardia Guidelines

Updated: Mar 13, 2017
  • Author: Adam S Budzikowski, MD, PhD, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Guidelines

Guidelines Summary

In 2015 the American College of Cardiology, American Heart Association and the Heart Rhythm Society (ACC/AHA/HRS) released joint guidelines for the management of supraventricular tachycardia that includes specific recommendations for both acute and ongoing management of atrial tachycardia. [34]

Acute atrial tachycardia

Recommendations for acute treatment are summarized below. [34]

Hemodynamically unstable patients

  • Intravenous (IV) adenosine (class IIa; level of evidence [LOE]: C-LD)
  • Synchronized cardioversion, if IV adenosine is ineffective or not feasible (class I; LOE: C-LD)

Hemodynamically stable patients

  • IV beta blockers, diltiazem, or verapamil (class I; LOE: C-LD)
  • IV adenosine, if the diagnosis is suspected but not established (class IIa; LOE: B-NR)
  • IV amiodarone or ibutilide, if beta blockers, diltiazem, verapamil, or adenosine are ineffective (class IIb; LOE: C-LD)

Ongoing atrial tachycardia

Catheter ablation is preferred treatment. (Class I; LOE: B-NR)

Other therapeutic options include the following:

  • Oral beta blockers, diltiazem, or verapamil (class IIa; LOE: C-LD)
  • Flecainide or propafenone in patients without structural heart disease or ischemic heart disease (class IIa; LOE: C-LD)
  • Oral sotalol or amiodarone (class IIb; LOE: C-LD)

Multifocal atrial tachycardia (MAT)

The guidelines emphasize that the first-line treatment is management of the underlying condition. Cardioversion and antiarrhythmic medications were not found to be helpful in suppression of MAT.

For acute treatment in patients with MAT, IV metoprolol or verapamil were recommended; for ongoing management of recurrent symptomatic MAT, oral verapamil (class IIa; LOE: B-NR), metoprolol, or diltiazem may be used. (All class IIa; LOE: C-LD) [34]