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

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

's electrical impulse comes from an ectopic pacemaker (that is, an abnormally located

cardiac pacemaker image:ConductionsystemoftheheartwithouttheHeart-en.svg, 350px, Image showing the cardiac pacemaker or SA node, the primary pacemaker within the electrical conduction system of the heart The cardiac pacemaker is the heart's natural rhythm gener ...

) in the upper chambers (

atria Atria may refer to: Science *Atrium (heart) (plural: atria), an anatomical structure of the heart *Atria (genus), a flatworm genus in the family Dendrocoelidae * Atria (star) or Alpha Trianguli Australis, a star in the constellation Triangulum Aus ...

) of the heart, rather than from the

sinoatrial node The sinoatrial node (also known as the sinuatrial node, SA node, sinus node or Keith–Flack node) is an ellipse, oval shaped region of special cardiac muscle in the upper back wall of the right atrium made up of Cell (biology), cells known as pa ...

, 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 ...

(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 Atmospheric entry (sometimes listed as Vimpact or Ventry) is the movement of an object from outer space into and through the gases of an atmosphere of a planet, dwarf planet, or natural satellite. Atmospheric entry may be ''uncontrolled entr ...

),''Curr Opin Cardiol.'' 2001 Jan;16(1):1–7. "Basic mechanisms of reentrant arrhythmias". Antzelevitch C. 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 (MAT), focal atrial tachycardia and

atrial flutter Atrial flutter (AFL) is a common abnormal heart rhythm that starts in the atrial chambers of the heart. When it first occurs, it is usually associated with a fast heart rate and is classified as a type of supraventricular tachycardia (SVT). ...

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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 caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

, 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 (CHD ...

. Other possible etiologies are listed below: * Hypoxia *

Pulmonary disease Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bron ...

Ischemic heart disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of heart disease involving the reduction of blood flow to the cardiac muscle due to a build-up of atheromatous plaque in the ...

Stimulants Stimulants (also known as central nervous system stimulants, or psychostimulants, or colloquially as uppers) are a class of drugs that increase alertness. They are used for various purposes, such as enhancing attention, motivation, cognitio ...

cocaine Cocaine is a tropane alkaloid and central nervous system stimulant, derived primarily from the leaves of two South American coca plants, ''Erythroxylum coca'' and ''Erythroxylum novogranatense, E. novogranatense'', which are cultivated a ...

caffeine Caffeine is a central nervous system (CNS) stimulant of the methylxanthine chemical classification, class and is the most commonly consumed Psychoactive drug, psychoactive substance globally. It is mainly used for its eugeroic (wakefulness pr ...

chocolate Chocolate is a food made from roasted and ground cocoa beans that can be a liquid, solid, or paste, either by itself or to flavoring, flavor other foods. Cocoa beans are the processed seeds of the cacao tree (''Theobroma cacao''); unprocesse ...

, ephedra *

Alcohol Alcohol may refer to: Common uses * Alcohol (chemistry), a class of compounds * Ethanol, one of several alcohols, commonly known as alcohol in everyday life ** Alcohol (drug), intoxicant found in alcoholic beverages ** Alcoholic beverage, an alco ...

* 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 or SANS, sympathetic autonomic nervous system, to differentiate it from the somatic nervous system) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous sy ...

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