Focal Atrial Tachycardia I:
Clinical Features, Diagnosis,Mechanisms, and Anatomic Location
KURT C. ROBERTS-THOMSON, PETER M. KISTLER, and JONATHAN M. KALMAN
From the Department of Cardiology, Royal Melbourne Hospital and the Department of Medicine, University of Melbourne, Melbourne, Australia
Atrial tachycardia (AT) may be focal or macroreentrant. In this review we will concentrate on focal AT.The diagnosis of focal AT may be made from a standard electrocardiogram (ECG); however, in some casesdifferentiation from other forms of supraventricular tachycardia may be difﬁcult. Focal AT may be dueto several different mechanisms, including abnormal automaticity, triggered activity, and microreentry.Focal AT does not occur randomly throughout the atria but has a characteristic anatomic distribution. Inthis review, we particularly focus on the clinical features, diagnosis, mechanisms, and anatomic locationof focal AT. (PACE 2006; 29:643–652)
focal atrial tachycardia
Focalatrialtachycardia(AT)isarelativelyun-common arrhythmia. In this review, we will con-centrate on the clinical features, diagnosis, mech-anisms, and anatomic locations of focal AT. FocalATisoftenrelatedtoanatomicalstructuresandhasdiffering arrhythmia mechanisms. These mecha-nismsincludeabnormalautomaticity,triggeredac-tivity, and reentry.
Deﬁnition of Focal AT
In2001,theJointExpertGroupfromtheWork-ing Group of Arrhythmias of the European Societyof Cardiology and the North American Society of PacingandElectrophysiologyclassiﬁedregularATaccordingtoelectrophysiologicalmechanismsandanatomical structures.
Regular AT may be classi-ﬁed as focal or macroreentrant. Focal AT was de-ﬁned as atrial activation starting rhythmically at asmall area (focus) from which it spreads out cen-trifugally and without endocardial activation oversigniﬁcant portions of the cycle length. The maintenet of this deﬁnition is that atrial activity origi-nates from a point source. In contrast, macroreen-trant activation is conventionally deﬁned as acircuit with a diameter of greater than 2 cm indiameter and frequently occurs around a centralobstacle.
Nonsustained AT is commonly found onHolter recordings and is seldom associated with
Address for reprints: Jonathan M. Kalman, M.B.B.S., Ph.D.,F.A.C.C., Department of Cardiology, Royal Melbourne Hospi-tal, Melbourne, Australia 3050. Fax: 61 3 9347 2808; e-mail:email@example.comDr. Kurt Roberts-Thomson and Dr. Peter Kistler are the recipi-ents of a Postgraduate Research Scholarship from the NationalHealth and Medical Research Council of Australia.Received June 27, 2005; revised September 21, 2005; acceptedOctober 12, 2005.
symptoms. However, sustained AT is relativelyrare. AT accounts for 5–15% of adults undergo-ing electrophysiological studies for paroxysmalSVT,
with higher rates in children. Poutiainenet al.
investigated the prevalence of AT in asymp-tomatic young individuals and in patients attend-inganarrhythmiaclinic.Theprevalenceinasymp-tomatic young individuals was calculated to be0.34%,withaprevalenceof0.46%ofsymptomaticpatients. In contrast to other supraventriculartachycardias,malesandfemalesappearequallyaf-fected.
Kammeraad et al.
described a group of patients with nonautomatic AT and reported thattheyoccurredpredominantlyinwomen.However,no gender difference was noted by Chen et al.
In general, automatic AT tends to be a conditionwhich affects the young, whereas AT due to mi-croreentry is more common in older populations,althoughmanyexceptionstothisoccur.
Olderpa-tients are also more likely to have right-sided ATand multiple AT.
The atrial rate during focal AT usually ranges between130and250beats/min,butmaybeaslowas 100 beats/min or as high as 300 beats/min. Ingeneral, younger patients tend to have faster AT,with rates up to 340 beats/min described in in-fants.
The properties of the atrial focus may besimilar to that of the sinus node in that they areresponsive to changes in activity and autonomictone.Ratesduringsleepmaybeupto40beats/minless than those during waking hours.
Patients may experience a spectrum of symp-toms, from being asymptomatic to complete inca-pacitation. Symptoms include palpitations, dizzi-ness, chest pain, dyspnea, fatigue, and syncope.Feeding problems, vomiting, and tachypnea may be seen in young children. The onset of symptomsmay occur at any age, from birth through to oldage. Rodriguez et al.
investigated the age of on-set in both adults and children and showed that
2006, The Authors. Journal compilation
2006, Blackwell Publishing, Inc.
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