Atrial tachycardia what is it

Atrial tachycardia occurs most commonly in elderly patients and those with other types of heart disease, though it occasionally appears in children, younger people and those with healthy hearts. Causes include:. But when atrial tachycardia is an occasional event, an office ECG may be normal. If this is the case, your doctor may give you an ECG monitor to wear at home that will record your heart rhythm over time.

These include:. However, treatment decisions are based on a more fine-tuned study of where and how the electrical signals are produced. Your doctor may recommend an electrophysiological study of your heart, during which a narrow, flexible tube called a catheter is threaded through a vein to your heart under light sedation.

Fine wires inside the catheter can help pinpoint the origin of the errant electrical signal. Atrial tachycardia Atrial tachycardia is an abnormally fast heartbeat. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Ectopic supraventricular rhythms. Merck Manual Professional Version. Accessed Feb. Supraventricular tachycardia. Symptoms of atrial tachycardia depend on the ventricular rate and the duration of the tachycardia.

The symptoms include palpitations from the rapid heart rate. If hypotension ensues, dizziness and weakness can occur.

The shortened diastolic filling time during tachycardic states can lead to decreased cardiac output and symptoms of congestive heart failure. Atrial tachycardia is best treated with AV blocking medications, such as beta-blockers or non-dihydropyridine calcium channel blockers.

Atrial tachycardias are the least frequent form of supraventricular tachycardias in the general population. The mechanisms of the arrhythmia could be abnormal automaticity, triggered activity, or reentry that is limited to atrial tissue.

Atrial tachycardias are a form of supraventricular tachycardia and can be classified as focal or macro-reentrant, depending on their origin and propagation of the electrical impulse. They can also be classified by the mechanism of the arrhythmia. Focal atrial tachycardias are frequently assumed to be due to automaticity although micro-reentry and triggered activity are possible and difficult to demonstrate in practice.

Macro-reentrant atrial tachycardias involve the participation of a reentry circuit within the atria. Neither the compact atrioventricular node AV node nor the accessory pathways participate in the mechanism of this arrhythmia. Atrial tachycardias can also be classified by the anatomic atrial structure where they originate from or that is involved in the reentry circuit i.

The clinical presentation of this arrhythmia varies significantly from short, rather sporadic, paroxysmal runs to incessant tachycardia.

Atrial tachycardias are often misdiagnosed as panic attacks and anxiety like any supraventricular tachycardia. The arrhythmia is commonly documented in the surface electrocardiogram as a narrow complex tachycardia and generically diagnosed as a supraventricular tachycardia.

A definitive diagnosis of an atrial tachycardia may be only possible through specific clinical or electrophysiologic features of the arrhythmia requiring electrocardiography and sometimes even intracardiac recordings. Occasionally incessant atrial tachycardias can present as congestive heart failure secondary to dilated cardiomyopathy. The diagnosis of tachycardia-induced cardiomyopathy and adequate treatment of the atrial tachycardia could be life saving and result in complete resolution of the cardiomyopathy.

Hemodynamic instability is possible but rather rare during atrial tachycardias. The diagnostic confirmation of an atrial tachycardia requires detailed analysis of electrocardiographic or intracardiac electrogram recordings. Definitive diagnosis can be suspected but not confirmed in clinical grounds only. The clinical suspicion of an atrial tachycardia is usually brought by symptoms compatible with a supraventricular tachycardia.

Short bursts of tachycardia in between sustained episodes may suggest the diagnosis of atrial tachycardia but can be seen with any other form of supraventricular tachycardia. During atrial tachycardias, the P—R interval is usually normal, although in the presence of AV nodal disease the P—R interval could be prolonged. A rare but potentially fatal presentation is tachycardia induced cardiomyopathy with the constellation of symptoms caused by progressive systolic heart failure including edema, dyspnea on exertion, orthopnea and paroxysmal nocturnal dyspnea with documented depressed left ventricular systolic function in the setting of persistent tachycardia.

Key symptoms: palpitations, chest discomfort, dyspnea at rest or exertion, dizziness, fatigue, near syncope, rarely syncope or could be asymptomatic. Key physical signs: regular tachycardia, unusual blood pressure either higher or lower than baseline , pallor or flushing, rapid vascular peripheral pulsation waves, heart failure signs can be present when the tachycardia is associated with heart failure.

Focal and reentrant atrial tachycardias have overlapping characteristics but may present with different clinical patterns and prevalence among different patient populations. Both can lead to tachycardia-induced cardiomyopathy when incessant over periods of several weeks or months. Focal atrial tachycardias are rather infrequent and most commonly seen in normal hearts and younger patients, although they could develop at any age.

They can present as an incessant tachycardia, which makes the diagnosis easier or as intermittent episodes of palpitations, as any other paroxysmal supraventricular tachycardia of sudden onset and offset. Focal atrial tachycardias can show acceleration and deceleration in response to changes in the autonomic tone with slight rate variations. Their origin has been described from multiple atrial and vascular structures within the atria, including crista terminalis, along the tricuspid and mitral annulus, pulmonary veins, fossa ovalis, coronary sinus, mitral annulus-aorta junction, vein of Marshall and atrial appendages Figure 1, Figure 2.

Electrocardiogram of a 6-year-old patient presenting with an incessant atrial tachycardia and tachycardia-induced cardiomyopathy. An electrophysiology study demonstrated a focal atrial tachycardia originating in the anterior rim of the fossa ovalis. Radiofrequency ablation resulted in elimination of the tachycardia and resolution of the cardiomyopathy later on. Three dimensional nonfluoroscopic activation map of a focal atrial tachycardia originating in the mitral annulus-aorta continuity.

Both right and left atria are shown with color-coded representation of the timing intervals. The red area represents early activation and the solid circle the earliest area of activation where radiofrequency ablation resulted in termination of the tachycardia. LAO: left anterior oblique. TA: tricuspid annulus. MA: mitral annulus.

RSPV: right superior pulmonary vein. LSPV: left superior pulmonary vein. LIPV: left inferior pulmonary vein. Macro-reentrant atrial tachycardias are more frequent among patients with a history of structural heart disease, prior cardiac surgery, chronic obstructive pulmonary disease, pulmonary hypertension, prior ablation procedures involving the atria, or any other clinical condition leading to atrial dilatation or atrial scaring.

Macro-reentrant atrial tachycardias could resemble typical cavo-tricuspid isthmus dependent atrial flutter using a puristic definition atrial flutter itself could be considered a form of macroreentrant atrial tachycardia and are frequently persistent although they could be paroxysmal as well Figure 3, Figure 4. Electrocardiogram of a year-old man presenting with an asymptomatic tachycardia.

The electrocardiogram is suggestive of an atypical atrial flutter with variable atrioventricular conduction. An electrophysiology study demonstrated a macro-reentrant atrial tachycardia around the mitral annulus with an area of slow conduction medial to the left atrial appendage on the anterior mitral annulus.

Solid arrows point to the atrial tachycardia waves in lead V1. Three-dimensional nonfluoroscopic activation map of the macro-reentrant atrial tachycardia depicted in Figure 3.

An area of slow conduction on the anterior mitral annulus medial to the left atrial appendage constituted the isthmus of the reentry circuit. Red solid circles correspond to the ablation lesions. The solid arrows indicate the direction of activation of the tachycardia across the isthmus.

Color coding corresponds to activation timing. Areas red-yellow correspond to early activation and blue-purple late activation. The anatomic location where early meets late corresponds to the isthmus of the tachycardia. LAA: left atrial appendage. Short, self-terminated runs of atrial tachycardia are rather common in ambulatory heart rhythm monitor recordings; but when asymptomatic and sporadic, they are frequently dismissed as incidental findings and not considered a clinical entity.

Atrial tachycardias become more prevalent with age at the expense of a higher representation of macro-reentrant atrial tachycardias in the older population, while focal atrial tachycardias become rather rare. Focal atrial tachycardias are more common among younger patients with normal hearts. A gender difference in the prevalence of these arrhythmias is not clear, although higher prevalence of focal automatic atrial tachycardias in women has been reported.

The other forms of supraventricular tachycardia are very difficult to differentiate from atrial tachycardias from the clinical standpoint:.

Atypical AV nodal reentrant tachycardia fast-slow or slow-slow AVNRT : electrocardiographically very difficult to differentiate from an atrial tachycardia. An electrophysiology study may be necessary to make a definitive diagnosis. Atrioventricular reentrant tachycardia AVRT : during tachycardia, the P waves are usually close to the preceding QRS in AVRT resulting in a rather long P—R interval, which suggests a diagnosis different than atrial tachycardia but still possible in atrial tachycardias with prolonged P—R.

Permanent junctional reciprocating tachycardia a unique form of AV reentrant tachycardia using a slow conducting retrograde accessory pathway : because of the participation of a slowly conducting accessory pathway as the retrograde limb of the tachycardia, this arrhythmia has retrograde P waves with a superior axis close to the following QRS resulting in a relatively normal P—R interval and very difficult to differentiate from an atrial tachycardia.

The incessant nature of this arrhythmia, younger age of presentation, and frequent presentation as tachycardia-induced cardiomyopathy help lead the clinical differential diagnosis towards this entity. Junctional ectopic tachycardia: rather rare and more common in children. As a focal tachycardia originating in AV nodal tissue, it clinically presents similar to focal atrial tachycardias, but the electrocardiographic recordings are similar to those of typical AV nodal reentrant tachycardia usually showing absence of P waves that are simultaneous and obscured by the QRS.

An electrophysiology study with pacing maneuvers is necessary to make a definitive diagnosis. Ventricular tachycardia: any supraventricular tachycardia that conducts to the ventricle with aberrancy resulting in a wide complex tachycardia, either due to bundle branch block or intraventricular conduction delay underlying at baseline or developed during tachycardia , could resemble ventricular tachycardia.

The clinical setting, characteristics of the arrhythmia, and AV relationship are useful in establishing the diagnosis, although not infrequently an electrophysiology study with intracardiac recordings is needed.