Focal atrial tachycardia

Focal atrial tachycardia occurs in the settings of structurally normal heart, 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, and dyspnoea.

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

A trial of adenosine can help differentiate focal AT from other supraventricular tachycardias.

Initial therapy should be guided by cause, comorbid conditions, haemodynamic status, and patient preference. First-line options for hemodynamically stable patients include intravenous beta-blockers or calcium-channel blockers, or catheter ablation.

For sustained focal atrial tachycardia, cardiology consultation, class Ic or III anti-arrhythmic agents, and ablative therapy are appropriate.

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, congenital heart disease, and cardiomyopathy. Focal AT is often confused with other regular supraventricular tachycardias, specifically re-entrant 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.