Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ KEY FEATURES +++ ESSENTIALS OF DIAGNOSIS ++ Atrial rate of 120–240 bpm P waves different from sinus P wave Structural heart disease in most cases +++ GENERAL CONSIDERATIONS ++ Occurs with supraventricular tachycardia in 6% of the population P-wave morphology is different from sinus P-wave morphology and differentiates it from sinus node reentry and inappropriate sinus tachycardia May present in the adult following prior atrial surgery for congenital heart disease Occurs in paroxysms that are frequently sustained, responding to vagal maneuvers only 25% of the time Precipitated by closely coupled atrial depolarization and does not exhibit warm-up phase The substrate that facilitates reentry is inhomogeneity of atrial conduction, refractoriness, or both +++ CLINICAL PRESENTATION +++ SYMPTOMS AND SIGNS ++ Palpitations Dyspnea +++ PHYSICAL EXAM FINDINGS ++ Usually findings of underlying structural heart disease Many patients have features of heart failure such as S3, elevated jugular venous distention, and rales in the lung fields +++ DIFFERENTIAL DIAGNOSIS ++ Automatic atrial tachycardia Atypical atrioventricular (AV) nodal reentrant tachycardia +++ DIAGNOSTIC EVALUATION +++ LABORATORY TESTS ++ CBC, basic metabolic panel +++ ELECTROCARDIOGRAPHY ++ ECG: may document rhythm disturbance or point to underlying heart disease Outpatient cardiac monitoring to detect rhythm disturbance +++ IMAGING STUDIES ++ Echocardiogram to evaluate structural heart disease +++ DIAGNOSTIC PROCEDURES ++ Invasive electrophysiologic study to assess rhythm mechanism +++ TREATMENT +++ CARDIOLOGY REFERRAL ++ All patients should be evaluated by a cardiac electrophysiologist +++ HOSPITALIZATION CRITERIA ++ If the patient has active heart failure or is hemodynamically unstable +++ MEDICATIONS ++ Beta blockers or calcium channel blockers with negative chronotropic properties (verapamil or diltiazem) Amiodarone, class IC, and other class III drugs are alternatives when the arrhythmia is difficult to control +++ THERAPEUTIC PROCEDURES ++ Radiofrequency ablation of the slow conduction area that facilitates macroreentry is associated with high success rate AV nodal ablation followed by permanent pacemaker implantation is a last resort if the arrhythmia cannot be ablated (very rare) +++ SURGERY ++ Generally not required +++ MONITORING ++ ECG monitoring in hospital +++ DIET AND ACTIVITY ++ Depends on underlying cause +++ ONGOING MANAGEMENT +++ HOSPITAL DISCHARGE CRITERIA ++ After radiofrequency ablation or adequate rate control on medications +++ FOLLOW-UP ++ Two weeks after discharge from ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Download the Access App: iOS | Android Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.