Multifocal atrial tachycardia

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Multifocal atrial tachycardia Microchapters

Overview

Historical Perspective

Pathophysiology

Causes

Epidemiology and Demographics

Natural History, Complications and Prognosis

Diagnosis

Treatment

Prevention

Differentiating Multifocal Atrial Tachycardia from other Diseases

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor-In-Chief: Sara Mohsin, M.D.[2], Cafer Zorkun, M.D., Ph.D. [3], Syed Hassan A. Kazmi BSc, MD [4]

Synonyms and Keywords: MAT, Chaotic atrial tachycardia, Supraventricular tachycardia

Overview

Multifocal atrial tachycardia (MAT) is a cardiac arrhythmia which is specifically a type of supraventricular tachycardia with an irregular, rapid atrial rhythm arising from multiple ectopic foci within the atria with a heart rate exceeding 100 beats per minute. It is characterized by an organized atrial activity yielding three or more different non-sinus P wave morphologies in the same lead with variable or irregular PP, PR and RR intervals. There's an isoelectric baseline between P waves with the most P waves being conducted to the ventricles and some R waves being aberrantly conducted. This variability pattern makes MAT look irregular on the surface ECG, thus oftenly leading to misinterpretion as atrial fibrillation. It is typically seen in elderly patients with a variety of underlying comorbidities, the most common being chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) and eventually it develops into atrial fibrillation. A rhythm with similar ECG characteristics but at a slow rate is referred to as multifocal atrial rhythm (MAR). The pathogenesis of MAT is not well understood and the patients are generally asymptomatic with mostly being hemodynamically stable. Typically, no treatment is required beyond treatment of underlying conditions in the majority of the MAT patients. However, it is very important to evaluate such patients as this arrhythmia is a poor prognostic sign in the setting of an acute illness.

Historical Perspective

Pathophysiology

Proposed theories suggesting the underlying mechanism of MAT
Theory Description
Theory of re-entry
Theory of abnormal automaticity
Theory of triggered activity
Multifocal Atrial Tachycardia.

Causes

Following is a list of potential causes of multifocal atrial tachycardia:

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated and include the following:

Common Causes


Causes by Organ System

Cardiovascular Congestive heart failure, myocardial infarction,
Chemical/Poisoning No underlying causes
Dental No underlying causes
Dermatologic No underlying causes
Drug Side Effect Aminophylline,, theophylline
Ear Nose Throat No underlying causes
Endocrine Diabetes mellitus
Environmental No underlying causes
Gastroenterologic No underlying causes
Genetic No underlying causes
Hematologic No underlying causes
Iatrogenic Postoperative complication
Infectious Disease Pneumonia, sepsis
Musculoskeletal/Orthopedic No underlying causes
Neurologic No underlying causes
Nutritional/Metabolic No underlying causes
Obstetric/Gynecologic No underlying causes
Oncologic Lung cancer
Ophthalmologic No underlying causes
Overdose/Toxicity Aminophylline
Psychiatric No underlying causes
Pulmonary Chronic obstructive pulmonary disease, hypoxia, lung cancer, pneumonia, pulmonary embolism
Renal/Electrolyte Chronic renal failure, hypokalemia, hypomagnesemia
Rheumatology/Immunology/Allergy No underlying causes
Sexual No underlying causes
Trauma No underlying causes
Urologic No underlying causes
Miscellaneous No underlying causes

Causes in Alphabetical Order

Epidemiology and Demographics

Natural history, Complications and Prognosis

Diagnosis

The diagnosis of MAT is usually not clinical rather the following electrocardiographic diagnostic criteria is used:

Electrocardiography

ECG of MAT has following characteristics:

Other diagnostic workup

Challenges in MAT pediatric patients

Challenges faced by pediatric practitioners while treating children with multifocal atrial tachycardia
Challenges Details
How to detect MAT early
How to control MAT
How deep to investigate etiologies of MAT[30]
How to predict another arrhythmia and outcome[2][26][31][32]

History and Symptoms

Physical Examination

Treatment

Treatment options for multifocal atrial tachycardia
Treatment option Description
Treat underlying medical condition
Magnesium repletion[33][34][35][36][37][38][39][26][40][36]


Potassium repletion[34]
Non-dihydropyridine calcium channel blockers
Beta blockers
Antiarrhythmic drugs[41][31][42]
Radiofrequency AV nodal ablation

Prevention

Primary Prevention

Differentiating Multifocal Atrial Tachycardia from other Diseases

Multifocal atrial tachycardia must be differentiated from the following:

Arrhythmia Rhythm Rate P wave PR Interval QRS Complex Response to Maneuvers Epidemiology Co-existing Conditions
Atrial fibrillation (AFib)[43][44]
  • Absent
Atrial flutter[45]
Atrioventricular nodal reentry tachycardia (AVNRT)[46][47][48][49]
  • Regular
Multifocal atrial tachycardia[50][51]
Paroxysmal supraventricular tachycardia
  • Regular
  • 150 and 240 bpm
  • Absent
  • Hidden in QRS
  • Absent
Premature atrial contractrions (PAC)[52][53]
  • Upright
  • Usually narrow (< 0.12 s)
Wolff-Parkinson-White Syndrome[54][55]
  • Regular
Ventricular fibrillation (VF)[56][57][58]
  • Absent
  • Absent
Ventricular tachycardia[59][60]
  • Regular
  • > 100 bpm (150-200 bpm common)
  • Absent

References

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