The AHA Guidelines and Scientific Statements Handbook

Chapter 16 Supraventricular Arrhythmias

cardioversion is often ineffective, but may result in
termination of micro re-entrant or triggered atrial
rhythms.
Long-term management of FAT involves initial
trials of AV nodal blocking agents; failing this
approach one can try Class iC agents (fl ecainide/
propafenone) or sotalol or amiodarone. Catheter
ablation may be used as primary therapy for these
patients (Table 16.6). Catheter ablation is associated
with 80–90% success rate for right atrial foci and

70–80% success rate for left atrial foci. The inci-

dence of complications is low (1%) and includes AV

block for septal foci and complication related to the

transseptal procedure and left atrial ablation (see

Table 16.6).

Newer studies related to patients with FAT have

involved better application of atrial site localization

by means of surface ECG criteria [29]. In addition

an exciting new technique involving detection of the

atrial focus by means of multi-electrode surface

Table 16.6 Recommendation for treatment of focal atrial tachycardia

Clinical situation Recommendation Classifi cation Level of evidence

Acute treatment†
A. Conversion
Hemodynamically unstable patient DC cardioversion I B
Hemodynamically stable patient Adenosine IIa C
Beta blockers IIa C
Verapamil, diltiazem IIa C
Procainamide IIa C
Flecainide/propafenone IIa C
Amiodarone, sotalol IIa C

B. Rate regulation* (in absence of digitalis therapy) Beta blockers I C
Verapamil, diltiazem I C
Digoxin IIb C

Prophylactic therapy
Recurrent symptomatic AT Catheter ablation I B
Beta blockers, calcium-channel blockers I C
Disopyramide‡ IIa C
Flecainide/propafenone‡ IIa C
Sotalol, amiodarone IIa C

Asymtomatic and symtomatic incessant Als Catheter ablation I B

Nonsustained and asymptomatic No therapy I C
Catheter ablation III C

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily refl ect a preferred sequence of admin-
istration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With
Atrial Fibrillation.

• Excluded are patients with MAT in whom beta-blockers and sotalol are often contraindicated due to pulmonary disease.
  † All listed drugs for acute treatment are administered intravenously.
  ‡ Flecainide, propafenone, and disopyramide should not be used unless they are combined with an AV-nodal–blocking agent.
  AF indicates strial tachycardia; DC, direct current; MAT, multifocal atrial tachycardia.