Multifocal Atrial Tachycardia (Chaotic Atrial Tachycardia)

Abstract

Multifocal atrial tachycardia, also designated "chaotic atrial tachycardia," was identified in the records of 31 patients. It was particularly noted that the arrhythmia progressed to atrial fibrillation or flutter in 17 cases (55%). Unifocal or multifocal premature atrial contractions preceded the arrhythmia in 20 cases (64%). The arrhythmia developed during an acute illness in 18 cases (58%). However, it occasionally occurred in paroxysms without an apparent cause in patients with chronic disease. Significant acute or chronic pulmonary disease was present in 12 cases (39%). The arrhythmia was not associated with digitalis toxicity or with rhythm disturbances known to occur in digitalis intoxication such as paroxysmal atrial tachycardia with block. In general, digitalis therapy seemed to have little effect on the course of the arrhythmia, but in some cases it appeared to be beneficial, especially if atrial fibrillation supervened. In several patients there seemed to be a transition from multifocal premature atrial contractions through chaotic atrial tachycardia to atrial fibrillation. These observations suggested that chaotic atrial tachycardia might be a forewarning of atrial fibrillation and that the two arrhythmias may have a similar mechanism.

Mechanism and Management of Chaotic Atrial Mechanism

“…CAM was more frequently found in patients who were acutely ill and was nonparoxysmal more often than paroxysmal in nature. In agreement with Lipson and Naimi [22], we found CAM was clearly associated with atrial fibrillation but was not related to atrial flutter. Since 'wandering pacemaker' usually refers to supraventricular escape complexes during sinus bradycardia [31], Shine et al [32] and Phillips et al [26] differ entiated between the two rhythms.…”

“…Although diabetes mellitus is common among patients with CAM, this relationship remains unclear. While digi talis toxicity is said to cause CAM [6,7], we find that although CAM may coexist with digitalis administration, it is usually not the offender [22,26]. CAM was more frequently found in patients who were acutely ill and was nonparoxysmal more often than paroxysmal in nature.…”

“…as well as augment the calcium pool within the myocyte [10]. Use of catecholamines and methylxanthine derivatives is common in patients with chronic lung disease and led L ipson and Naimi [22] to postulate that these pharmacologic agents were responsible for precipitating CAM.…”

Multifokale atriale Tachykardie im Kindesalter

“…Eine wesentlich seltenere supraventrikuläre Herzrhythmusstörung ist die multifokale atriale Tachykardie (MAT) oder chaotische Vorhoftachykardie [7,10,15,26,49]. Diese Herzrhythmusstö-rung muß insofern von anderen tachykarden Vorhofrhythmusstörungen abgegrenzt werden, da sich für sie eine andere therapeutische Therapiestrategie ergibt [30,32,37,52].…”

Irregular Cardiac Rhythm in a Woman with Asthma

“…Multifocal atrial tachycardia is often mistaken for atrial fi brillation. Although it is a distinct nosological entity, multifocal atrial tachycardia is often preceded or followed by other atrial arrhythmias, such as atrial fi brillation, atrial fl utter, and other atrial tachycardias (2,4). Multifocal atrial tachycardia usually disappears when the underlying medical problem has been controlled.…”