Atrial Tachycardia

This is part of: Supraventricular Rhythms

Atrial tachycardia has a more or less regular heart rate > 100 bpm, with narrow QRS complexes but P-waves that do not originate from the sinus node but from another site in the atria. The P-waves therefore have a different configuration and their non-sinus origin can easily be recognized if the P waves are negative in I and/or aVF.

In this narrow complex tachycardia with a normal morphology of the QRS-complexes (thus no ventricular tachycardia) you can see that there is AV-association (i.e. every QRS complex is preceded by a P-wave) but the P-waves are inverted (negative in aVF), therefore this is an atrial tachycardia

In some (ill) patients the atrial tachycardia may originate from multiple atrial sites and therefore may have varying P-wave morphologies, PR-intervals (AV block may occur) and subsequent variable ventricular frequencies.

Vagal stimulation (carotid sinus massage) should lower AV conduction and will then clearly show the fast atrial rhythm dissociating from the ventricular rhythm (AV dissociation due to AV block). Atrial tachycardias may be treated with antiarrhythmic drugs or ablation.

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