Atrial Tachycardia Overview
Atrial tachycardia is a form of supraventricular tachycardia, originating within the atria but outside of the sinus node. Both atrial flutter and multifocal atrial tachycardia are specific types of atrial tachycardia.
AKA: Paroxysmal Atrial Tachycardia (PAT), unifocal atrial tachycardia, ectopic atrial tachycardia
Pathophysiology of Atrial Tachycardia
- Usually due to single ectopic focus.
- The underlying mechanism can involve reentry, triggered activity or increased automaticity.
- May be paroxysmal or sustained.
- Multiple causes including digoxin toxicity, atrial scarring, catecholamine excess, congenital abnormalities; may be idiopathic.
- Sustained atrial tachycardia may rarely be seen and can progress to tachycardia-induced cardiomyopathy
ECG Features of Atrial Tachycardia
- Atrial rate > 100 bpm.
- P wave morphology is abnormal when compared with sinus P wave due to ectopic origin.
- There is usually an abnormal P-wave axis (e.g. inverted in the inferior leads II, III and aVF)
- At least three consecutive identical ectopic p waves.
- QRS complexes usually normal morphology unless pre-existing bundle branch block, accessory pathway, or rate related aberrant conduction.
- Isoelectric baseline (unlike atrial flutter).
- AV block may be present — this is generally a physiological response to the rapid atrial rate, except in the case of digoxin toxicity where there is actually AV node suppression due to the vagotonic effects of digoxin, resulting in a slow ventricular rate (“PAT with block”).
Ectopic atrial tachycardia:
- There is a narrow complex tachycardia at 120 bpm.
- Each QRS complex is preceded by an abnormal P wave — upright in V1, inverted in the inferior leads II, III and aVF.
Ectopic atrial tachycardia:
- There is a narrow complex tachycardia at 95 bpm.
- Each QRS complex is preceded by an abnormal P wave — biphasic in V1; inverted in the inferior leads II, III and aVF; and inverted V3-V6
- Poutiainen AM et al. Prevalence and natural course of ectopic atrial tachycardia. Eur Heart J. 1999 May;20(9):694-700. PMID: 10208790
LITFL Further Reading
- ECG Library Basics – Waves, Intervals, Segments and Clinical Interpretation
- ECG A to Z by diagnosis – ECG interpretation in clinical context
- ECG Exigency and Cardiovascular Curveball – ECG Clinical Cases
- 100 ECG Quiz – Self-assessment tool for examination practice
- ECG Reference SITES and BOOKS – the best of the rest
- Brady WJ, Truwit JD. Critical Decisions in Emergency and Acute Care Electrocardiography
- Surawicz B, Knilans T. Chou’s Electrocardiography in Clinical Practice: Adult and Pediatric
- Wagner GS. Marriott’s Practical Electrocardiography 12e
- Chan TC. ECG in Emergency Medicine and Acute Care
- Rawshani A. Clinical ECG Interpretation
- Mattu A. ECG’s for the Emergency Physician
- Hampton JR. The ECG In Practice, 6e