Focal atrial tachycardia

Last reviewed: 30 May 2022
Last updated: 04 Mar 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cardiac disease
More key diagnostic factors

Other diagnostic factors

  • medications
  • palpitations
  • fatigue, weakness
  • chest pain
  • shortness of breath, cough
  • nausea, vomiting
  • light-headedness, syncope
  • rales
  • oedema
Other diagnostic factors

Risk factors

  • coronary artery disease
  • substance misuse (alcohol ingestion/withdrawal, cocaine, amphetamines)
  • digoxin toxicity
  • exacerbation of chronic lung disease
  • previous cardiac surgery to correct congenital heart defects
More risk factors

Diagnostic investigations

1st investigations to order

  • ECG
  • digoxin level
  • theophylline level
  • CXR
  • electrolytes
  • toxicology screen
More 1st investigations to order

Investigations to consider

  • vagal manoeuvres, adenosine
  • thyroid-stimulating hormones
  • echocardiogram
  • ambulatory 24-hour (Holter) ECG or event recorder
  • electrophysiological study (EPS)
More investigations to consider

Treatment algorithm

INITIAL

adult: undifferentiated supraventricular tachycardia

ACUTE

adult: focal AT; digoxin excess not suspected

adult: focal AT; digoxin toxicity suspected

child

ONGOING

adult: sustained or recurrent focal AT

Contributors

Authors

Sarah Stahmer, MD

Associate Professor

Department of Emergency Medicine

University of North Carolina

Chapel Hill

NC

Disclosures

SS declares that she has given lectures regionally and nationally that include paroxysmal atrial tachycardia.

Peer reviewers

Amal Mattu, MD

Associate Professor of Emergency Medicine

University of Maryland Medical Center

Baltimore

MD

Disclosures

AM declares that he has no competing interests.

Vias Markides, MB(Hons), BS(Hons), MD, FRCP

Consultant Cardiologist

Royal Brompton & Harefield NHS Trust

Imperial College London

London

UK

Disclosures

VM declares that he has no competing interests.

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  • Differentials

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    • Atrial flutter
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  • Guidelines

    • 2019 ESC guidelines for the management of patients with supraventricular tachycardia
    • ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia
    More Guidelines
  • Patient leaflets

    Atrial fibrillation: what is it?

    Atrial fibrillation: what treatments work?

    More Patient leaflets
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