Navigating the fine line between focal atrial tachycardia and atrial flutter?

Author:

Rahimpour Feisal12,Hemmati Roohullah1,Anafje Mohsen3,Soltani Hadis4,Majid Haghjoo13,Ebrahimi Pouya5ORCID

Affiliation:

1. Department of Electrophysiology, Rajaei Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran

2. Department of Pediatric Cardiology, Rajaei Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran

3. Cardiac Electrophysiology Research Center, Rajaei Cardiovascular Medical and Research Center Iran University of Medical Sciences Tehran Iran

4. Department of Biomedical Engineering, Faculty of Engineering Center Tehran Branch, Islamic Azad University Tehran Iran

5. Tehran Heart Center Cardiovascular Disease Research Institute, Tehran University of Medical Sciences Tehran Iran

Abstract

Key Clinical MessageFocal atrial tachycardia (FAT) is an organized atrial rhythm >100 beats per minute initiated from a discrete origin and spreading over both atria in a centrifugal pattern. The arrhythmia may be sustained or incessant. Dynamic forms with recurrent interruptions and reinitiating may be frequent. In this report, we present a 36‐year‐old man who came to the emergency room complaining of palpitation and shortness of breath. All laboratory evaluations were normal. With an initial electrocardiogram (ECG) the patient was admitted with the initial diagnosis of atrial flutter. Finally, after the electrophysiologist's examination, with the diagnosis of FAT, ablation was successfully performed. Atrial tachycardia (AT), excluding atrial fibrillation (AF) and cavotricuspid isthmus‐dependent atrial flutter (AFL), account for 10% of supraventricular tachycardia referred for ablation procedures. More than 70% of these cases are focal and occur in patients with no records of cardiac surgery or ablation of AF. FAT originating from the right pulmonary veins (PV) can be challenging to differentiate from atrial flutter due to their proximity and overlapping symptoms. The right PV is close to the right atrium, and the abnormal electrical activity in FAT may mimic the organized circuit found in atrial flutter. Distinguishing between FAT and atrial flutter is crucial for choosing the best therapeutic option. This can be done most of the time by focusing on the differences in the pattern of their P and QRS waves, R‐R wave intervals, and also their baseline changes on ECG, as well as their cycle duration, response to adenosine and risk factors of the patient.

Publisher

Wiley

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