Multifocal atrial tachycardia

Background

Multiple (3 or more) ectopic foci in the atria causing an irregular atrial tachycardia
Increased automaticity due to causes listed below

Causes

COPD
CHF
Sepsis
Methylxanthine toxicity / Theophylline toxicity
Electrolyte abnormalities
Other associations
- Valvular heart disease
- DM
- Acute renal failure
- Postoperative state
- Pulmonary embolism
- Pneumonia
- Anemia

Clinical Features

Multifocal atrial tachycardia

Differential Diagnosis

Narrow-complex tachycardia

Regular
- AV Node Independent
  - Sinus tachycardia
  - Atrial tachycardia (uni-focal or multi-focal)
  - Atrial fibrillation
  - Atrial flutter
- AV Node Dependent
  - Paroxysmal supraventricular tachycardia (PSVT)
    - AV node re-entry tachycardia (AVNRT)
    - AV re-entry tachycardia (AVRT)
      - Lown-Ganong-Levine syndrome
      - Wolff–Parkinson–White syndrome
  - Junctional tachycardia
Irregular
- Multifocal atrial tachycardia (MAT)
- Sinus tachycardia with frequent PACs
- Atrial fibrillation
  - Atrial fibrillation with RVR
- Atrial flutter with variable conduction

Palpitations

Arrhythmias:
Non-arrhythmic cardiac causes:
Psychiatric causes:
- Panic attack
- Anxiety
- Somatic Symptom Disorder
Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
Misc

Evaluation

ECG
- Irregular tachycardia (>100 bpm)
- At least 3 distinct p wave morphologies
- No dominant pacemaker site
BMP, Magnesium
Hemoglobin/hematocrit
Consider infectious disease work up
Consider ABG/VBG

Management

Treat underlying cause
Replace magnesium
Replace potassium
Increased AV nodal activity is unlikely to be effective
- Vagal maneuvers and adenosine may help reveal underlying rhythm/p-waves
- Can consider beta-blocker or calcium channel blocker in hemodynamically stable patient
  - Use beta-blockers cautiously in patients with pulmonary disease
Cardioversion not definitive
- MAT likely to recur if underlying etiology not addressed

Disposition

Disposition depends on underlying illness, but often requires admission due to illness severity
Poor prognostic sign when MAT develops during hospitalization or acute illness
- 60% in-hospital mortality
  - Due to illness, not arrhythmia
- Mean survival around 1 year

See Also

External Links

References

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