Focal atrial tachycardia

Occurs in the settings of coronary artery disease, congestive heart failure, cardiac surgery, catecholamine ingestion, digoxin toxicity, and alcohol dependency.

Symptoms and signs include palpitations, fatigue, pre-syncope/syncope, chest pain.

ECG shows a regular atrial tachycardia with P-wave morphology different from that in sinus tachycardia.

Treatment consists of a trial of adenosine, withdrawal of the causative agent, or treatment of the underlying cause. For sustained tachycardias, cardiology consultation, class Ia/Ic or III anti-arrhythmic agents, and ablative therapy are appropriate.

Complications include haemodynamic instability and congestive heart failure.

Focal atrial tachycardia (focal AT) is characterised as a rapid regular rhythm arising from a discrete area within the atria. It occurs in a wide range of clinical conditions, including catecholamine excess, digoxin toxicity, paediatric congenital heart disease, and cardiomyopathy. Focal AT is a regular tachycardia and is often confused with other regular supraventricular tachycardias, specifically re-entry tachycardias, sinus tachycardia, and atrial flutter. It may be difficult to diagnose by ECG alone. The diagnosis of focal AT is usually based on ECG, clinical history, and response to interventions such as vagal manoeuvres and adenosine.