Focal Atrial Tachycardia
Let’s talk about focal atrial tachycardia.
Focal atrial tachycardia is characterized by at least three or more consecutive ectopic P waves with similar morphology, usually arising from a single ectopic focus.
Criteria
- ≥3 consecutive similar ectopic P waves (usually inverted in inferior leads).
- Atrial rate >100 bpm.
- QRS usually narrow unless pre-existing BBB or aberrant conduction.
Note the inverted P waves with similar morphology and atrial rate of 160 bpm and PR interval >110 msec (0.11 sec).
Same rhythm strip with graphical explanation.
Illustration.
Possible causes: Drug abuse, digoxin toxicity, hypoxia, catecholamine release, alcohol, exercise, congenital heart disease, others.
NOTE: Focal atrial tachycardia with AV block is usually mistaken for atrial flutter.
NOTE: The ventricular rate may varies, depending on AV nodal conduction.
NOTE: Sometimes atrial tachycardia is mistaken for junctional tachycardia when the retrograde P waves appear before the QRS (negative P wave). If the PR interval >0.11 sec. indicates atrial focus, if the PR interval <0.11 sec. indicates junctional origin.
NOTE: A negative P wave in leads I and aVL suggests left atrial origin.
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