Atrial tachycardia

Overview

Atrial tachycardia is an irregular heartbeat, called an arrhythmia. It's a type of supraventricular tachycardia.

During an atrial tachycardia episode, the heart beats more than 100 times a minute. Then it returns to a heart rate of around 60 to 80 beats a minute. An episode may start slowly, or it may start suddenly and quickly. It can cause a pounding or racing heartbeat, lightheadedness, dizziness, and fainting.

Atrial tachycardia is common. It may happen in people who have had heart surgery or who are pregnant. Infections, stimulant medicines or alcohol use may trigger it.

Symptoms

The main symptom of atrial tachycardia is a very fast heartbeat. Typically during atrial tachycardia, the heart beats 150 to 200 times a minute. The fast heartbeat may come and go suddenly, or it can be ongoing.

Other symptoms of atrial tachycardia may include:

• Pounding or fluttering feelings in the chest or neck, called palpitations.
• Chest pain.
• Fainting or almost fainting.
• Lightheadedness or dizziness.
• Shortness of breath.
• Sweating.
• Weakness or extreme tiredness.
• Nausea.

Some people with atrial tachycardia do not notice symptoms.

Atrial tachycardia symptoms may be hard to see in infants and young children. Symptoms of atrial tachycardia in children can include:

• Poor feeding.
• Sweating.
• Irritability.
• Changes in skin color.

If your infant or young child has any of these symptoms, talk with a healthcare professional.

When to see a doctor

Symptoms of atrial tachycardia may be related to a serious health condition. Call 911 or your local emergency number if you have a very fast heartbeat that lasts for more than a few minutes or if a fast heartbeat occurs with these symptoms:

• Chest pain.
• Dizziness.
• Shortness of breath.
• Weakness.

Make an appointment for a healthcare checkup if you have:

• A very fast heartbeat for the first time.
• An irregular heartbeat that lasts longer than a few seconds.

Causes

Atrial tachycardia is caused by faulty electrical signals in the heart. These electrical signals control the heartbeat.

In atrial tachycardia, a change in these signals makes the heartbeat start too early in the heart's upper chambers. This causes the heart to beat too fast. Then the heart is not able to fill with blood properly.

Risk factors

Anyone can get atrial tachycardia. But some health conditions or treatments can increase your risk. Atrial tachycardia risk factors include:

• Heart conditions such as coronary artery disease, heart valve disease and other heart diseases.
• Heart failure.
• Heart condition present at birth, called a congenital heart defect.
• Previous heart surgery.
• Sleep apnea.
• Thyroid disease.
• Lung disease, including chronic obstructive pulmonary disease (COPD).
• Diabetes.
• Some medicines, including those used to treat asthma, allergies and colds.

Other things that may increase the risk of atrial tachycardia include:

• Emotional stress.
• Too much caffeine.
• Heavy alcohol use, defined as more than 15 drinks a week for men and eight or more drinks a week for women.
• Smoking and nicotine use.
• Stimulant drugs, including cocaine and methamphetamine.

Complications

Atrial tachycardia isn't usually life-threatening. However, it can be a concern if you have heart damage or another heart condition. If the very fast heartbeat continues, it may weaken the heart muscle.

Diagnosis

To diagnose atrial tachycardia, a healthcare professional examines you and listens to your heart. A member of your healthcare team takes your blood pressure. You are usually asked questions about your symptoms, health habits and medical history.

Tests

Tests and procedures to diagnose atrial tachycardia may include:

• Blood tests. Blood tests can check for thyroid disease, heart disease or other conditions that can affect the heartbeat.
• Electrocardiogram (ECG or EKG). This is the most common test to diagnose tachycardia. An ECG shows how the heart is beating. Small sensors, called electrodes, attach to the chest and sometimes the arms and legs. Wires connect the sensors to a computer, which prints or displays results.
• Holter monitor. A Holter monitor is a small ECG device. It is worn for a day or more to record the heart's activity during daily activities.
• Echocardiogram. Also called a heart ultrasound, this test uses sound waves to make pictures of the beating heart. It shows the heart's size and structure. It also shows how blood moves through the heart and heart valves.

Other tests may be done to try to trigger an episode of atrial tachycardia. The tests can give more information about the heart.

• Exercise test, also called a stress test. During a stress test, the heart's activity is watched while you ride on a stationary bicycle or walk on a treadmill. If you can't exercise, you may be given medicine that affects the heart in a way that's similar to exercise.
• Electrophysiological (EP) study and cardiac mapping. An EP study is a series of tests that show how electrical signals spread through the heart during each heartbeat. It may be done to confirm tachycardia or to find where in the heart the faulty signaling occurs. The test is done in a hospital.

Treatment

Treatment of atrial tachycardia depends on what causes it and how severe it is. Treatment may include:

• Vagal maneuvers. Simple but specific actions such as coughing, putting an ice pack on the face or pushing down as if having a bowel movement can help slow down the heart rate. These actions affect the vagus nerve, which helps control the heartbeat.
• Medicines. Medicines may be given to control the heart rate and reset the heart rhythm. Some medicines may need to be given by IV.
• Cardioversion. Paddles or patches on the chest are used to give an electrical shock to the heart. The quick, low-energy shock resets the heart's rhythm. This may be a treatment option if atrial tachycardia doesn't get better with vagal maneuvers or medicine.
• Catheter ablation. A doctor guides a thin, flexible tube called a catheter through a blood vessel, usually in the groin, and up to the heart. Sometimes more than one catheter is used. Sensors on the tip of the catheter use heat energy, called radiofrequency energy, to create tiny scars in the heart. The scar tissue blocks faulty electrical signals. This restores a regular heartbeat.
• Pacemaker. A pacemaker is a small device that's placed in the chest to help control the heartbeat. When it finds an irregular heartbeat, it sends an electrical signal that helps correct the heart's rhythm. A pacemaker may be needed if other treatments for atrial tachycardia don't work. For people with atrial tachycardia, a pacemaker is typically placed during with a treatment called AV node ablation.

Preparing for an appointment

If you have a very fast heartbeat, call your healthcare professional. If the fast heartbeat is severe and lasts longer than a few minutes, seek immediate medical help.

Your healthcare professional may send you to a doctor trained in heart diseases, called a cardiologist. You also might see a doctor trained in heart rhythm disorders, called an electrophysiologist.

Because appointments can be brief, it's helpful to be prepared. Here's how to get ready for your visit.

What you can do

Before the appointment, call your healthcare professional's office to see if there are any special instructions you need to follow. For example, you may be told not to drink or eat before a cholesterol test. Make a list of details to share with your healthcare team. Your list may include:

• Any symptoms, even those that may not seem related to atrial tachycardia.
• Important personal information, including any big life changes or major stresses.
• All medicines you take, such as vitamins, supplements and other medicines bought without a prescription. Include the doses.
• Questions for your care team.

Make a list of questions for your healthcare team. Questions might include:

• What is causing my fast heart rate?
• What tests do I need?
• What treatment do you recommend?
• What are the risks of atrial tachycardia?
• How often do I need checkups?
• How do my other health conditions or medicines affect my heartbeat?
• Do I need to change my diet or activities?
• Is there any helpful information I can take home? What websites do you recommend?

Be sure to ask any other questions you may have during your appointment.

What to expect from your doctor

Your healthcare team is likely to ask you many questions. Being ready to answer them may save time and give you a chance to talk about any concerns you have. Your care team may ask:

• When did your symptoms start?
• How often does your heart race?
• How long does your fast heartbeat last?
• What makes your symptoms worse?
• Do you always have symptoms, or do they come and go?
• Does anyone in your family have heart disease or a history of irregular heartbeats?
• Has anyone in your family died suddenly or had sudden cardiac arrest?
• Do you smoke or have you ever smoked?
• How much caffeine or alcohol do you use, if any?
• What medicines are you taking?
• Do you have any health conditions such as high blood pressure, high cholesterol or diabetes that could affect your heart health?