Overview
What is included in the workup of atrial tachycardia?
What are the signs and symptoms of atrial tachycardia?
How is atrial tachycardia treated?
How is multifocal atrial tachycardia treated?
How is atrial tachycardia defined?
How is atrial tachycardia classified?
How is atrial tachycardia diagnosed and treated?
Which cardiac anatomy is relevant to atrial tachycardia?
Which anatomic abnormalities may be present at the site of atrial tachycardia?
How are the pathophysiologic mechanisms of atrial tachycardia differentiated?
What is the role of enhanced automaticity in the pathophysiology of atrial tachycardia?
What is the role of triggered activity in the pathophysiology of atrial tachycardia?
What is the role of pulmonary vein tachycardias in atrial tachycardia?
What is the pathophysiology of intra-atrial reentry tachycardia?
What is the pathophysiologic classification of atrial tachycardia?
What causes atrial tachycardia?
What is the prevalence of atrial tachycardia?
Which age groups have the highest prevalence of atrial tachycardia?
What is the prognosis of atrial tachycardia?
What is the prognosis of multifocal atrial tachycardia?
What is included in patient education about atrial tachycardia?
Presentation
Which clinical history findings are characteristic of atrial tachycardia?
What is the focus of the clinical history to evaluate for atrial tachycardia?
Which clinical history findings are characteristic of multifocal atrial tachycardia?
Which physical findings are characteristic of atrial tachycardia?
DDX
Which conditions are included in the differential diagnoses of atrial tachycardia?
What is the role of ECG analysis in differentiating atrial tachycardia from other diagnoses?
What is required to diagnose atrial tachycardia?
Which conditions are included in the differential diagnoses of multifocal atrial tachycardia?
How is atrial tachycardia differentiated from inappropriate sinus tachycardia?
What are the differential diagnoses for Atrial Tachycardia?
Workup
Which tests are initially performed in the workup of atrial tachycardia?
Which lab tests are performed in the workup of atrial tachycardia?
Which cardiac tests may be beneficial in the workup of atrial tachycardia?
How are systemic disorders excluded in the workup of atrial tachycardia?
What is the role of imaging studies in the workup of atrial tachycardia?
What is the role of ECG in the workup of atrial tachycardia?
What is the role of ECG in the workup of multifocal atrial tachycardia?
What is the role of echocardiography in the workup of atrial tachycardia?
What is the role of electrophysiology studies in the workup of atrial tachycardia?
What is the role of endocardial mapping in the workup of reentrant sinoatrial tachycardia?
What is the role of endocardial mapping in the workup of focal atrial tachycardia?
What is the role of home telemetry in the workup of atrial tachycardia?
Treatment
What is the primary treatment during an episode of atrial tachycardia?
What is the role of cardioversion in the treatment of atrial tachycardia?
Which medications are used in the treatment of atrial tachycardia?
What is the role of class Ia and Ic antiarrhythmics in the treatment of atrial tachycardia?
What is the role of class III antiarrhythmics in the treatment of atrial tachycardia?
How is digitalis intoxication treated in patients with atrial tachycardia?
How is multifocal atrial tachycardia treated?
How is multifocal atrial tachycardia treated in the emergency department (ED)?
What is the role of catheter ablation in the treatment of atrial tachycardia?
How is atrial fibrillation treated in atrial tachycardia?
What is the role of catheter ablation in the treatment of reentrant atrial tachycardia?
How is congenital heart disease treated in patients with atrial tachycardia?
Which specialist consultations are beneficial to patients with atrial tachycardia?
Guidelines
Which guidelines have been issued on the treatment of atrial tachycardia?
Which medications were omitted from the 2019 revision of the ESC/AEPC atrial tachycardia guidelines?
What are the new recommendations in the 2019 revision of the ESC/AEPC atrial tachycardia guidelines?
What are the EHRA treatment guidelines for sinus tachycardia?
What are the EHRA treatment guidelines for focal atrial tachycardia?
What are the EHRA guidelines on the treatment of AV nodal reentrant tachycardia (AVNRT)?
What are the EHRA guidelines on the treatment of atrial tachycardia during pregnancy?
Which organizations have endorsed the 2017 EHRA guidelines on atrial tachycardia?
What are the EHRA guidelines on acute management of atrial tachycardia?
What are the EHRA guidelines on the treatment of SVTs with adult congenital heart disease?
What are the EHRA guidelines on the treatment of focal junctional tachycardia?
What are the EHRA guidelines on the treatment of asymptomatic preexcitation?
What are the ACC/AHA/HRS guidelines on the treatment of acute atrial tachycardia?
What are the ACC/AHA/HRS guidelines on the treatment of ongoing atrial tachycardia?
What are the ACC/AHA/HRS guidelines on the treatment of multifocal atrial tachycardia?
Where are guidelines on atrial tachycardia found online?
Medications
What is the role of medications in the treatment of atrial tachycardia?
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Atrial tachycardia. This 12-lead electrocardiogram demonstrates an atrial tachycardia at a rate of approximately 150 beats per minute. Note that the negative P waves in leads III and aVF (upright arrows) are different from the sinus beats (downward arrows). The RP interval exceeds the PR interval during the tachycardia. Note also that the tachycardia persists despite the atrioventricular block.
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Atrial tachycardia. This propagation map of a right atrial tachycardia originating from the right atrial appendage was obtained with non-contact mapping using the EnSite mapping system.
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Atrial tachycardia. Note that the atrial activities originate from the right atrium and persist despite the atrioventricular block. These features essentially exclude atrioventricular nodal reentry tachycardia and atrioventricular tachycardia via an accessory pathway. Note also that the change in the P-wave axis at the onset of tachycardia makes sinus tachycardia unlikely.
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Atrial tachycardia. An anterior-posterior mapping projection is shown. This is an example of activation mapping using contact technique and the EnSite system. The atrial anatomy is partially reconstructed. Early activation points are marked with white/red color. The activation waveform spreads from the inferior/lateral aspect of the atrium through the entire chamber. White points indicate successful ablation sites that terminated the tachycardia. CS = shadow of the catheter inserted in the coronary sinus; TV = tricuspid valve.
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Atrial tachycardia. These intracardiac tracings showing atrial tachycardia breaking with the application of radiofrequency energy. Before ablation, the local electrograms from the treatment site preceded the surface P wave by 51 ms, consistent with this site being the source of the tachycardia. Note that postablation electrograms on the ablation catheter are inscribed well past the onset of the sinus rhythm P wave. The first three tracings show surface electrocardiograms as labeled. Abl = ablation catheter (D-distal pair of electrodes); CS = respective pair of electrodes of the coronary sinus catheter; CS 1,2 = distal pair of electrodes; CS 7,8 = electrodes located at the os of the coronary sinus.
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Atrial tachycardia. This image shows an example of rapid atrial tachycardia mimicking atrial flutter. A single radiofrequency application terminates the tachycardia. The first three tracings show surface electrocardiograms, as labeled. AblD and AblP = distal and proximal pair of electrodes of the mapping catheter, respectively; HBED and HBEP = distal and proximal pair of electrodes in the catheter located at His bundle, respectively; HRA = high right atrial catheter; MAP = unipolar electrograms from the tip of the mapping catheter; RVA = catheter located in right ventricular apex.
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Atrial tachycardia. This electrocardiogram shows multifocal atrial tachycardia (MAT).
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Atrial tachycardia. This electrocardiogram belongs to an asymptomatic 17-year-old male who was incidentally discovered to have Wolff-Parkinson-White (WPW) pattern. It shows sinus rhythm with evident preexcitation. To locate the accessory pathway (AP), the initial 40 milliseconds of the QRS (delta wave) are evaluated. Note that the delta wave is positive in lead I and aVL, negative in III and aVF, isoelectric in V1, and positive in the rest of the precordial leads. Therefore, this is likely a posteroseptal AP.
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Atrial tachycardia. This is a 12-lead electrocardiogram from an asymptomatic 7-year-old boy with Wolff-Parkinson-White (WPW) pattern. Delta waves are positive in leads I and aVL; negative in II, III, and aVF; isoelectric in V1; and positive in the rest of the precordial leads. This again predicts a posteroseptal location for the accessory pathway (AP).