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ECG Abnormalities_Part 20

Monday, June 25, 2012

A 65 year old male patient with end-stage COPD gets admitted to the ICU with respiratory failure. He was found to have the below ECG:

What are the ECG findings?
What is the treatment for this heart rhythm disorder?

ANSWER

The ECG findings include: 1) Multifocal atrial tachycardia (three distinct P wave morphologies) 2) Incomplete right bundle branch block 3) Poor R wave progression 4) PVCs

Multifocal atrial tachycardia (aka MAT) is an irregularly irregular, tachycaric rhythm in which many foci in the atium chaotically fire acting as the pacemaker of the heart instead of the sinus node. The atrial rate is not as fast as in atrial flutter or atrial fibrillation, so normal AV synchrony can occur. When the rhythm has 3 distinct P wave morphologies and the heart rate is not fast, the term "wandering atrial pacemaker" or WAP is used.

 The treatment of multifocal atrial tachycardia is aimed at the underlying cause. In this case it would be to treat the COPD exacerbation and respiratory failure. The only medication that has been used to treat MAT is verapamil with only marginal success. No anticoagulation is needed for MAT in contrast to atrial flutter/fibrillation since the atrium are contracting well, but simply originating in different areas.

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