History

Although atrial ectopic tachycardia (AET) is occasionally encountered in patients following surgery for congenital heart disease, most patients have structurally normal hearts and are symptomatic. Palpitations, chest pain, lightheadedness, presyncope, and dyspnea are the most common symptoms.

Asymptomatic or preverbal patients may be noted to be tachycardic or dyspneic on routine evaluation. Difficulty feeding or diaphoresis may accompany the tachycardia in infants.

Exercise intolerance and heart failure are late manifestations of secondary cardiac dysfunction.

The history must be sufficiently broad to rule out causes of persistently elevated heart rates, such as hyperthyroidism, anemia, or catecholamine-producing malignancy. The family history is rarely positive for atrial ectopic tachycardia.

Physical Examination

The heart rate is inappropriately elevated for the degree of activity. If second-degree atrioventricular (AV) block is present, the heart rate may be irregular. The patient may be tachypneic. In advanced cardiomyopathy, pulses and perfusion are poor, and evidence of cardiac enlargement is present. Hepatic and pulmonary congestion may be present.

Differential Diagnoses

Ge H, Li X, Liu H, Jiang H. Predictors of pharmacological therapy of ectopic atrial tachycardia in children. Pediatr Cardiol. 2017 Feb. 38(2):289-95. [QxMD MEDLINE Link].
Dagres N, Gutersohn A, Wieneke H, Sack S, Erbel R. A new hereditary form of ectopic atrial tachycardia with autosomal dominant inheritance. Int J Cardiol. 2004 Feb. 93(2-3):311-3. [QxMD MEDLINE Link].
Kanaya T, Nishigaki K, Yoshida Y, Nakamura Y, Murakami Y, Suzuki T. Ectopic atrial tachycardia originating from right atrial appendage aneurysms in children: Three case reports. HeartRhythm Case Rep. 2018 Jan. 4(1):2-5. [QxMD MEDLINE Link]. [Full Text].
Chandler SF, Whitehill RD, DeWitt ES, Alexander ME, Thompson FF, Mah DY. Ultra-rapid atrial pacing as a form of rate control in postoperative automatic arrhythmias in patients with congenital heart disease. HeartRhythm Case Rep. 2020 Apr. 6(4):215-8. [QxMD MEDLINE Link]. [Full Text].
Bauersfeld U, Gow RM, Hamilton RM, Izukawa T. Treatment of atrial ectopic tachycardia in infants Am Heart J</i>. 1995 Jun. 129(6):1145-8. [QxMD MEDLINE Link].
Salerno JC, Kertesz NJ, Friedman RA, Fenrich AL Jr. Clinical course of atrial ectopic tachycardia is age-dependent: results and treatment in children or =3 years of age. J Am Coll Cardiol. 2004 Feb 4. 43(3):438-44. [QxMD MEDLINE Link].
Gelb BD, Garson A Jr. Noninvasive discrimination of right atrial ectopic tachycardia from sinus tachycardia in "dilated cardiomyopathy". Am Heart J. 1990. 120:886-91. [QxMD MEDLINE Link].
Kistler PM, Roberts-Thomson KC, Haqqani HM, Fynn SP, Singarayar S, Vohra JK. P-wave morphology in focal atrial tachycardia: development of an algorithm to predict the anatomic site of origin. J Am Coll Cardiol. 2006 Sep 5. 48(5):1010-7. [QxMD MEDLINE Link].
Ge HY, Li XM, Tang XJ, Zhang Y, Liu HJ, Li YH. Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia. Eur J Pediatr. 2015 Aug. 174(8):1015-22. [QxMD MEDLINE Link].
Backhoff D, Klehs S, Müller MJ, Schneider HE, Dieks JK, Paul T, et al. Long-term follow-up after radiofrequency catheter ablation of accessory atrioventricular pathways in children. JACC Clin Electrophysiol. 2018 Apr. 4 (4):448-55. [QxMD MEDLINE Link]. [Full Text].
Higa S, Tai CT, Lin YJ, et al. Focal atrial tachycardia: new insight from noncontact mapping and catheter ablation. Circulation. 2004 Jan 6. 109(1):84-91. [QxMD MEDLINE Link]. [Full Text].
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. 2008 Aug. 10(8):972-81. [QxMD MEDLINE Link].
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. 2008 Mar. 29(2):393-7. [QxMD MEDLINE Link].
[Guideline] Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2016 Apr 5. 133(14):e471-505. [QxMD MEDLINE Link]. [Full Text].
Ge H, Li X, Zhang Y, Liu H, Jiang H. [Clinical course and treatment of ectopic atrial tachycardia in 144 children]. Zhonghua Er Ke Za Zhi. 2015 Mar. 53(3):214-9. [QxMD MEDLINE Link].
Janson CM, Tan RB, Iyer VR, Vogel RL, Vetter VL, Shah MJ. Ivabradine for treatment of tachyarrhythmias in children and young adults. HeartRhythm Case Rep. 2019 Jun. 5(6):333-7. [QxMD MEDLINE Link]. [Full Text].
Hackett G, Lin TK, Imundo JR. Use of ivabradine in a critically ill pediatric patient with recalcitrant ectopic atrial tachycardia and complex congenital heart disease. HeartRhythm Case Rep. 2022 Jun. 8(6):415-9. [QxMD MEDLINE Link]. [Full Text].
Karmegaraj B, Balaji S, Raju PN, et al. Tachycardia-induced cardiomyopathy secondary to incessant ectopic atrial tachycardia in two infants: Potential new indication for early initiation of enteral ivabradine. Ann Pediatr Cardiol. 2021 Jul-Sep. 14(3):422-7. [QxMD MEDLINE Link]. [Full Text].
Dubin AM, Jorgensen NW, Radbill AE, et al. What have we learned in the last 20 years? A comparison of a modern era pediatric and congenital catheter ablation registry to previous pediatric ablation registries. Heart Rhythm. 2019 Jan. 16(1):57-63. [QxMD MEDLINE Link].
Janson CM, Shah MJ, Kennedy KF, et al. Comparison of outcomes of pediatric catheter ablation by anesthesia strategy: a report from the NCDR IMPACT Registry. Circ Arrhythm Electrophysiol. 2021 Jul. 14(7):e009849. [QxMD MEDLINE Link]. [Full Text].

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Author

Shubhayan Sanatani, MD, FRCPC, FHRS Head, Division of Cardiology, Professor, Department of Pediatrics, University of British Columbia Faculty of Medicine; Medical Director, Children's Heart Centre, Section Head, Heart Rhythm Service, British Columbia Children's Hospital, Canada

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

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Emtelligent<br/>Received research grant from: Heart and Stroke Foundation of Canada.

Coauthor(s)

Robert Murray Hamilton, MD, MSc, FRCPC Electrophysiologist, Senior Associate Scientist, Physiology and Experimental Medicine, Labatt Family Heart Centre; Professor, Department of Pediatrics, University of Toronto Faculty of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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 Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, Western Society for Pediatric Research, American College of Cardiology, American Heart Association, American Pediatric Society

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Executive Director of The Heart Center, Interim Division Chief of Pediatric Cardiology, Lurie Childrens Hospital; Professor, Department of Pediatrics, Northwestern University, The Feinberg School of Medicine

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, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Additional Contributors

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, Heart Rhythm Society, Pediatric and Congenital Electrophysiology Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Sections Pediatric Atrial Ectopic Tachycardia
Overview
Presentation
DDx
Workup
Treatment
Guidelines
Medication
References

Pediatric Atrial Ectopic Tachycardia Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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