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Tachycardia: Difference between revisions
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ATs have a wide range clinical presentation. They can occur in paroxysms or can be the permanent underlying rhythm. Complaints of palpitation and a fast regular heart rate are common and as a result of the tachycardia complaints of dizziness, dyspnoea and syncope can be experienced. Focal AT that with a progressive increase at onset and decrease before termination are likely based on abnormal automaticity. Digoxine intoxication is a common cause for ATs. On the ECG an atrial tachycardia can be detected through the P-wave morphology. The P-wave has an other morphology depending on the foci of the atrial tachycardia. A ECG in resting condition of sinus rhythm can help distinguish different morphologies and help in localization of the source of the atrial tachycardia. Vagal maneuvers or administration of adenosine can block the AV-conduction and reveal firing from the atrium, thereby clearly identifying the atrial source of the tachycardia. Some ATs are sensitive to adenosine and will terminate after administration of adenosine. However sometimes only a electrophysiological study can differentiate between the different SVT and localize the precise location or circuit of the AT. | ATs have a wide range clinical presentation. They can occur in paroxysms or can be the permanent underlying rhythm. Complaints of palpitation and a fast regular heart rate are common and as a result of the tachycardia complaints of dizziness, dyspnoea and syncope can be experienced. Focal AT that with a progressive increase at onset and decrease before termination are likely based on abnormal automaticity. Digoxine intoxication is a common cause for ATs. On the ECG an atrial tachycardia can be detected through the P-wave morphology. The P-wave has an other morphology depending on the foci of the atrial tachycardia. A ECG in resting condition of sinus rhythm can help distinguish different morphologies and help in localization of the source of the atrial tachycardia. Vagal maneuvers or administration of adenosine can block the AV-conduction and reveal firing from the atrium, thereby clearly identifying the atrial source of the tachycardia. Some ATs are sensitive to adenosine and will terminate after administration of adenosine. However sometimes only a electrophysiological study can differentiate between the different SVT and localize the precise location or circuit of the AT. | ||
====Management:==== | ====Management:==== | ||
Vagal maneuvers or adenosine can be effective in terminating focal AT.<cite>Markowitz</cite> If AT persist and is drug-resistant DC cardioversion can be indicated. Recurrent episodes of AT can be prevented with anti-arrhythmic medication, for instance with beta-blockers or calcium antagonists. However not all AT are sensitive to medication and success rate of medication is usually low. If these drugs are unsuccessful Class Ic in combination with AV-nodal-blocking agents or Class III drugs can be tried. The treatment of choice for symptomatic AT is catheter ablation. In an experienced center up to 90% of the AT can be ablated. Multifocal atrial tachyardia is difficult therapy is usually directed at the management of underlying disease.<cite> | Vagal maneuvers or adenosine can be effective in terminating focal AT.<cite>Markowitz</cite> If AT persist and is drug-resistant DC cardioversion can be indicated. Recurrent episodes of AT can be prevented with anti-arrhythmic medication, for instance with beta-blockers or calcium antagonists. However not all AT are sensitive to medication and success rate of medication is usually low. If these drugs are unsuccessful Class Ic in combination with AV-nodal-blocking agents or Class III drugs can be tried.<cite>Chen1</cite> The treatment of choice for symptomatic AT is catheter ablation. In an experienced center up to 90% of the AT can be ablated. Multifocal atrial tachyardia is difficult therapy is usually directed at the management of underlying disease.<cite>Chen2, Anguere</cite> | ||
[[File:atrial arrhythmias.svg|thumb|500px|'''Figure 2.''' The different atrial arrhythmias. Note the differences in P wave morphology or absence of P-waves in case of atrial fibrillation.<cite>ECGPedia</Cite>]] | [[File:atrial arrhythmias.svg|thumb|500px|'''Figure 2.''' The different atrial arrhythmias. Note the differences in P wave morphology or absence of P-waves in case of atrial fibrillation.<cite>ECGPedia</Cite>]] | ||