Highlights & Basics
- Focal atrial tachycardia occurs in the settings of structurally normal heart, coronary artery disease, congestive heart failure, cardiac surgery, catecholamine ingestion, digoxin toxicity, and alcohol dependency.
- Symptoms and signs include palpitations, fatigue, presyncope/syncope, chest pain, and dyspnea.
- ECG shows a regular atrial tachycardia with P-wave morphology different from that in sinus tachycardia.
- A trial of adenosine can help differentiate focal AT from other supraventricular tachycardias.
- Initial therapy should be guided by cause, comorbid conditions, hemodynamic status, and patient preference. First-line options for hemodynamically stable patients include intravenous beta-blockers or calcium-channel blockers, or catheter ablation.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Focal atrial tachycardia in an 88-year-old woman with 2:1 AV nodal block in the setting of digoxin therapy and potassium 2.8 mEq/L
Focal atrial tachycardia in a 35-year-old with history of recent cocaine use
ECG following cardioversion of focal atrial tachycardia in a 35-year-old with history of recent cocaine use
Focal atrial tachycardia in a 55-year-old with ischemic cardiomyopathy
Diagnostic algorithm for differentiating atrial tachycardias from other narrow QRS tachycardias. AV = atrioventricular, PAC = premature atrial contraction
Response to adenosine 6 mg intravenously
Citations
Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2016 Apr 5;67(13):e27-e115.[Abstract][Full Text]
Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC guidelines for the management of patients with supraventricular tachycardia. The Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J. 2020 Feb 1;41(5):655-720.[Abstract][Full Text]
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