Skip to Main Content

KEY FEATURES

ESSENTIALS OF DIAGNOSIS

  • Heart rate 100–180 bpm

  • P-wave morphology different from sinus P waves

  • Initiated by an ectopic beat

  • Abrupt onset with increase in heart rate

GENERAL CONSIDERATIONS

  • Episodes may be brief and self-terminating or chronic and persistent

  • Structural heart disease is common, particularly coronary artery disease (including acute myocardial infarction), valvular heart disease, and cardiomyopathy

  • Concomitant atrial flutter or fibrillation is not uncommon

  • Continuous tachycardia may cause tachycardia cardiomyopathy

  • May be associated with digoxin toxicity

CLINICAL PRESENTATION

SYMPTOMS AND SIGNS

  • Palpitations

  • Dyspnea

  • Dizziness

  • Chest pain

PHYSICAL EXAM FINDINGS

  • Tachycardia

  • If the tachycardia is incessant, features of cardiomyopathy may be noted

DIFFERENTIAL DIAGNOSIS

  • Reentrant atrial tachycardia

  • Atypical atrioventricular (AV) nodal reentrant tachycardia

  • AV reentrant tachycardia with slowly conducting pathway

DIAGNOSTIC EVALUATION

LABORATORY TESTS

  • CBC, basic metabolic panel

  • Cardiac biomarkers

  • If the patient has features of congestive heart failure, measurement of brain natriuretic peptide

  • Measurement of serum digoxin level if appropriate

ELECTROCARDIOGRAPHY

  • ECG to define rhythm disturbance

  • Ambulatory cardiac monitoring to document frequency and duration of episodes

IMAGING STUDIES

  • Echocardiogram to exclude structural heart disease

DIAGNOSTIC PROCEDURES

  • Electrophysiology study to determine mechanism of rhythm disturbance

TREATMENT

CARDIOLOGY REFERRAL

  • All patients require cardiology assessment followed by electrophysiology referral as suggested by cardiologist

HOSPITALIZATION CRITERIA

  • Patients with sustained or symptomatic arrhythmia

MEDICATIONS

  • Common antiarrhythmic options include amiodarone, flecainide, propafenone, or sotalol

  • Beta blockers and calcium channel blockers are effective to slow the ventricular rate

  • Digoxin is uniformly ineffective

  • Type IA antiarrhythmic drugs are uniformly ineffective

  • Consider adenosine as some atrial tachycardias are adenosine sensitive

THERAPEUTIC PROCEDURES

  • Radiofrequency ablation

  • Success rate of ablation varies with the type and focus of the arrhythmia

  • Mapping and ablation of atrial tachycardia often more complex than other supraventricular tachycardias

SURGERY

  • Surgical excision and open cryoablation are not performed due to advances in catheter ablation

MONITORING

  • Patients managed by pharmacotherapy need ECG monitoring for effectiveness and assessment of side effects

DIET AND ACTIVITY

  • No specific change other than healthy lifestyle

ONGOING MANAGEMENT

HOSPITAL DISCHARGE CRITERIA

  • Twenty-four hours after ablation

FOLLOW-UP

  • Patients on pharmacotherapy may require follow-up every 3–6 months

COMPLICATIONS

  • Cardiomyopathy

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.