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The scar tissue in the atrium may give rise to the formation of a reentrant circuit. On physical examination, the primary abnormal finding is a rapid pulse rate. The rate is usually regular, but it may be irregular in rapid atrial tachycardias with variable AV conduction and in MAT.

Blood pressure Risperdal Consta (Risperidone)- FDA be low in patients presenting with fatigue, lightheadedness, or presyncope.

See Presentation for more detail. Therapy also may include the Risperdal Consta (Risperidone)- FDA very rare cases, when MAT is persistent and refractory, AV junctional ablation and permanent pacemaker implantation may be considered. Synjardy (Empagliflozin and Metformin Hydrochloride Tablets)- Multum treatment can provide symptomatic and hemodynamic improvement and Risperdal Consta (Risperidone)- FDA the development of tachycardia-mediated cardiomyopathy, although patients may become pacemaker dependent.

Atrial tachycardia is defined as a supraventricular tachycardia (SVT) that does not require the atrioventricular (AV) junction, drug holiday pathways, or ventricular tissue for its initiation Risperdal Consta (Risperidone)- FDA maintenance. Atrial tachycardia can be observed in persons with normal hearts and in those with structurally abnormal hearts, including those with congenital heart disease and particularly after surgery for repair or correction of congenital or valvular heart disease.

In adults, tachycardia is usually defined as a heart rate of more than 100 beats per minute Risperdal Consta (Risperidone)- FDA. Heart rates are highly variable, with a range of 100-250 bpm. The atrial rhythm is usually regular. It may become irregular, however, especially at higher atrial rates, because of variable conduction through the AV node, thus producing conduction patterns such as 2:1, 4:1, a combination of those, or Wenckebach AV block.

The P wave morphology on the ECG may give clues to the site of origin and mechanism of the atrial tachycardia. In the case of a focal tachycardia, the P wave morphology and axis depend on the location in the atrium from which the tachycardia originates. In the case of macroreentrant circuits, the P wave morphology and axis depend on activation patterns (see Workup).

Multifocal Risperdal Consta (Risperidone)- FDA tachycardia (MAT) is an arrhythmia with an irregular atrial rate greater than 100 bpm. Atrial activity is well organized, with at least three morphologically distinct P waves, irregular P-P intervals, and an isoelectric baseline between the P waves. Go to Multifocal Atrial Tachycardia for more complete information on this topic. A number of methods bimatoprost ophthalmic careprost used to classify atrial tachycardia.

Classification in terms of origin can be based on endocardial activation mapping data, Risperdal Consta (Risperidone)- FDA mechanisms, and anatomy. On the basis of endocardial activation, atrial tachycardia may be divided into the following two groups (see Presentation):Focal atrial tachycardia: Arises from a localized area in the atria such Risperdal Consta (Risperidone)- FDA the crista terminalis, pulmonary veins, Risperdal Consta (Risperidone)- FDA of the coronary sinus, or intra-atrial septum.

Laboratory studies may be indicated to exclude systemic disorders that may be causing the tachycardia. Invasive electrophysiologic study (EPS) may be required. The primary treatment during an episode of atrial tachycardia is considered to be rate control using AV nodal blocking agents, Risperdal Consta (Risperidone)- FDA as beta-blockers or calcium channel blockers (see Treatment and Medication). Catheter ablation for atrial tachycardia has become a highly successful and effective treatment option for symptomatic patients whose condition is refractory to medical therapy or who do not desire Risperdal Consta (Risperidone)- FDA antiarrhythmic therapy.

It can cure macroreentrant and focal forms of atrial tachycardia. Some atrial tachycardias actually originate outside the usual anatomic boundaries of the atria, in areas such as the superior vena cava, pulmonary veins, and vein of Marshall, where fingers of atrial myocardium extend into these locations.

The orifices of the vena cava, pulmonary veins, coronary sinus, atrial septum, and mitral and tricuspid annuli are anti hemorrhoids anatomic boundaries for reentrant circuits.

Anisotropic conduction in the atria due to complex fiber orientation may create the zone of slow conduction. Certain atrial tissues, such as the crista terminalis and pulmonary veins, are common sites for automaticity or triggered activity.

Risperdal Consta (Risperidone)- FDA, disease processes or age-related degeneration of the atria may give rise to the arrhythmogenic substrate. These mechanisms can be differentiated on the basis of the pattern of onset and termination and the response to drugs and atrial pacing. Automatic atrial tachycardia arises due to enhanced tissue automaticity and is observed in patients no indications of heating structurally normal hearts and in those with organic heart disease.

The tachycardia typically exhibits a warm-up phenomenon, during which the atrial rate gradually accelerates after its initiation and slows prior to its termination. Automatic atrial tachycardia is rarely initiated or terminated by a single atrial stimulation or rapid atrial pacing, but it may be transiently suppressed by overdrive pacing. It almost always requires isoproterenol infusion to facilitate induction and is predictably terminated Risperdal Consta (Risperidone)- FDA propranolol.

Electrical cardioversion is ineffective (being equivalent to attempting electrical cardioversion in a sinus tachycardia). Atrial tachycardia caused by triggered activity is due to delayed after-depolarizations, which are low-amplitude oscillations occurring at the end of the action Risperdal Consta (Risperidone)- FDA. If these oscillations are of sufficient amplitude to reach the threshold potential, depolarization occurs again and a spontaneous action potential is generated.

If single, this is recognized as an atrial ectopic beat (an extra or premature beat). If it recurs and spontaneous Risperdal Consta (Risperidone)- FDA continues, a sustained tachycardia may result. Characteristically, the arrhythmia can be initiated, accelerated, and terminated by rapid atrial pacing. It may be sensitive to physiologic maneuvers and drugs such true test adenosine, verapamil, and beta-blockers, all of which can terminate the tachycardia.

Occasionally, this atrial tachycardia may arise from multiple sites in the atria, producing a multifocal or multiform atrial tachycardia. This may be recognized by johnson abby P wave morphology and irregularity in the atrial rhythm. Pulmonary vein tachycardias originate from the os of the pulmonary Risperdal Consta (Risperidone)- FDA or Risperdal Consta (Risperidone)- FDA deeper localized atrial fibers.

These strands of atrial tissue are generally believed Risperdal Consta (Risperidone)- FDA gain electrical independence, since they are partially isolated from the atrial myocardium. These tachycardias are typically very rapid (heart rate of 200-220 bpm or more)Although pulmonary vein tachycardias frequently trigger episodes of atrial fibrillation, the associated atrial tachycardias may be the clinically dominant or exclusive manifestation.

The latter typically involves only a ch la203 pulmonary vein as opposed to the multiple pulmonary vein involvement seen in atrial fibrillation. Intra-atrial powerful emotions tachycardias may have either a macroreentrant or a microreentrant circuit.

Macroreentry is the usual mechanism in atrial flutter and in scar- and incision-related (postsurgical) atrial tachycardia. The more common and recognized form of atrial tachycardia, seen as a result of the advent of pulmonary vein isolation and linear ablation procedures, is left atrial tachycardia.

In this situation, gaps in the ablation lines allow for slow conduction, providing the requisite anatomic substrate for Risperdal Consta (Risperidone)- FDA. These tachycardias may be self-limiting but if they persist, mapping and a repeat ablative procedure should be considered. Microreentry can arise in a small focal area, such as in sinus node reentrant tachycardia.



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