Atrial tachycardia: mechanisms and management

Abstract

Atrial tachycardias comprise a heterogeneous group of arrhythmias that include focal atrial tachycardia, typical atrial flutter and atypical atrial flutter. Focal atrial tachyardias arise from automatic, triggered or microreentrant mechanisms, while typical and atypical flutters are macroreentrant in nature. Typical flutter describes a reentrant circuit that is dependant on the cavotricuspid isthmus in the right atrium while atypical flutter includes various lesional and de novo macroreentrant circuits in the right and left atria. Electrocardiographic criteria have been proposed to distinguish these mechanisms of tachycardia, but they are not specific; whereas adenosine often aids in the diagnosis. Management of focal atrial tachyardias and macroreentry centers around rate control, antiarrhythmic therapy, ablation and anticoagulation. Success rates for ablation are highest for typical atrial flutter and higher than antiarrhythmic therapy for most atrial tachycardias.

Keywords::

• atrial flutter
• atrial tachycardia
• atypical flutter
• macroreentry

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.