Atrial tachycardia is a type of heart rhythm problem in which the

heart The heart is a muscular organ in most animals. This organ pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide t ...

's electrical impulse comes from an

ectopic pacemaker An ectopic pacemaker, also known as ectopic focus or ectopic foci, is an excitable group of cells that causes a premature heart beat outside the normally functioning SA node of the heart. It is thus a cardiac pacemaker that is ectopic, producing ...

(that is, an abnormally located cardiac pacemaker) in the upper chambers ( atria) of the heart, rather than from the sinoatrial node, the normal origin of the heart's electrical activity. As with any other form of

tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal (su ...

(rapid heart beat), the underlying mechanism can be either the rapid discharge of an abnormal focus, the presence of a ring of cardiac tissue that gives rise to a circle movement ( reentry), or a triggered rapid rhythm due to other pathological circumstances (as would be the case with some drug toxicities, such as

digoxin toxicity Digoxin toxicity, also known as digoxin poisoning, is a type of poisoning that occurs in people who take too much of the medication digoxin or eat plants such as foxglove that contain a similar substance. Symptoms are typically vague. They may inc ...

Classification

Forms of atrial tachycardia (ATach) include

multifocal atrial tachycardia Multifocal (or multiform) atrial tachycardia (MAT) is an cardiac arrhythmia, abnormal heart rhythm, specifically a type of supraventricular tachycardia, that is particularly common in older people and is associated with exacerbations of chronic o ...

(MAT), focal atrial tachycardia and atrial flutter. CC-BY icon

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Paroxysmal atrial tachycardia (PAT) is an episode of arrhythmia that begins and ends abruptly.

Etiology

Atrial tachycardia tends to occur in individuals with structural heart disease, with or without

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, a ...

, and ischemic coronary artery disease. However, focal atrial tachycardia often occurs in healthy individuals without

structural heart disease Structural heart disease, also known as structural cardiac disease, is a collection of heart diseases that includes heart failure, coronary artery disease, hypertrophic cardiomyopathy, and congenital heart disease A congenital heart defect (CH ...

. Other possible etiologies are listed below: *

Hypoxia Hypoxia means a lower than normal level of oxygen, and may refer to: Reduced or insufficient oxygen * Hypoxia (environmental), abnormally low oxygen content of the specific environment * Hypoxia (medical), abnormally low level of oxygen in the tis ...

* Pulmonary disease *

Ischemic heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), ischemic heart disease (IHD), myocardial ischemia, or simply heart disease, involves the reduction of blood flow to the heart muscle due to build-up of atherosclerotic pla ...

Stimulants Stimulants (also often referred to as psychostimulants or colloquially as uppers) is an overarching term that covers many drugs including those that increase activity of the central nervous system and the body, drugs that are pleasurable and inv ...

cocaine Cocaine (from , from , ultimately from Quechuan languages, Quechua: ''kúka'') is a central nervous system (CNS) stimulant mainly recreational drug use, used recreationally for its euphoria, euphoric effects. It is primarily obtained from t ...

caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine class. It is mainly used recreationally as a cognitive enhancer, increasing alertness and attentional performance. Caffeine acts by blocking binding of adenosine t ...

chocolate Chocolate is a food made from roasted and ground cacao seed kernels that is available as a liquid, solid, or paste, either on its own or as a flavoring agent in other foods. Cacao has been consumed in some form since at least the Olmec civ ...

, ephedra *

Alcohol Alcohol most commonly refers to: * Alcohol (chemistry), an organic compound in which a hydroxyl group is bound to a carbon atom * Alcohol (drug), an intoxicant found in alcoholic drinks Alcohol may also refer to: Chemicals * Ethanol, one of sev ...

* Metabolic disturbances *

Digoxin toxicity Digoxin toxicity, also known as digoxin poisoning, is a type of poisoning that occurs in people who take too much of the medication digoxin or eat plants such as foxglove that contain a similar substance. Symptoms are typically vague. They may inc ...

* Heightened

sympathetic tone The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of t ...

A study noted 10 to 15% of patients presenting for

supraventricular tachycardia Supraventricular tachycardia (SVT) is an umbrella term for fast heart rhythms arising from the upper part of the heart. This is in contrast to the other group of fast heart rhythms – ventricular tachycardia, which start within the lower cham ...

(SVT) ablation had atrial tachycardia.

Diagnosis

Electrocardiographic features include: * Atrial rate: 100 to 250 BPM * Ventricular conduction can be variable ** Irregular or irregularly irregular in the setting of variable AV block ** Regular if 1 to 1, 2 to 1, or 4 to 1 AV block * P wave morphology ** Unifocal, but similar in morphology to each other ** Might be inverted ** Differs from normal sinus P wave * May exhibit either long RP or short PR intervals * Rhythm may be paroxysmal or sustained ** May demonstrate an increase in the rate at initiation (e.g., "warm up," or "rev up") ** May demonstrate a decrease in the rate at termination (e.g., "cool down")

Treatment

Initial management of focal atrial tachycardia should focus on addressing underlying causes: treating acute illness, cessation of stimulants, stress reduction, appropriately managing digoxin toxicity, or chronic disease management. The ventricular rate is controllable with the use of beta blockers or calcium channel blockers. If atrial tachyarrhythmia persists and the patient is symptomatic, the patient may benefit from class IA, IC, or class III antiarrhythmics. Catheter ablation of focal atrial tachycardia may be appropriate in patients failing medical therapy.

Epidemiology

A European study of young males applying for pilot licenses demonstrated that 0.34% had asymptomatic atrial tachycardia and 0.46% had symptomatic atrial tachycardia.

References

External links

{{Heart diseases Cardiac arrhythmia