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■ P different from normal sinus P waves

■ Atrial tachycardia with AV blockis classic for digoxin toxicity!

TREATMENT

■ Usually a stable rhythm, not requiring therapy

■ Treat underlying condition.

■ When treatment is needed because of signs of instability

■ Rate control with diltiazem, β-blockers

MUTIFOCALATRIALTACHYCARDIA(MAT)

A subset of atrial tachycardia, MAT occurs when multiple ectopic foci stimu-

late the atria.

CAUSES

Often associated with chronic lung disease and hypoxemia

ECG FINDINGS(SEEFIGURE1.9)

■ Irregular narrow complex tachycardia

■ P wave before each QRS

■ Multiple unique P waves present

TREATMENT

■ Usually a stable rhythm not requiring therapy (treat the pulmonary condition)

■ When treatment is needed because of signs of instability

■ Rate control with diltiazem, β-blockers

ATRIALFLUTTER

Atrial flutter is organized atrial electrical activity, usually without contractile

action.

CAUSES

■ Idiopathic

■ Hyperthyroidism or metabolic abnormalities

■ Stimulant use

■ Pericarditis

■ CHF

■ Valvular dysfunction

■ Acute or chronic lung disease

RESUSCITATION

FIGURE 1.9. Multifocal atrial tachycardia.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS. Emergency

Medicine: A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:184.)

Atrial tachycardia is typically

due to an underlying medical

(not a cardiac) condition.