Differences between multifocal atrial tachycardia, paroxysmal atrial tachycardia, and atrial fibrillation.

10% of the US population of 80 years of age and above suffer from atrial fibrillation. Sometimes, the patient does not notice atrial fibrillation for a long time, which results in sufficient cardiac remodeling. This makes establishing a sinus rhythm very difficult. 

In this video, Dr. Syed discusses the definition, presentation, pathology, EKG, and salient points of management of the atrial fibrillation. The following aspects are discussed in detail:

1. Loss of atrial function during the episodes of the atrial fibrillation.
2. The risk of thrombus formation and duration of fibrillation where this risk increases significantly so that cardioversion is contra-indicated.
3. Atrial fibrillation caused by failing heart and ischemic injury.
4. Cardiac remodeling at a macro and cellular level during the long-standing atrial fibrillation and why cardioversion becomes difficult.
5. Development of the reentry circuits and the need for catheter ablation.
6. EKG interpretation of the atrial fibrillation.
7. JVP changes (absence of the A wave) during the atrial fibrillation.
8. The absence of the S4 heart sound due to the atrial fibrillation where this abnormal sound is expected.
9. Pharmacological management and cardioversion approaches.
10. Catheter ablation indication and possible methods.
11. Clinical types/stages of atrial fibrillation.

EKG – difference between MAT and PAT

Posted on July 31, 2017

MAT stands for multifocal atrial tachycardia.

PAT stands for Paroxysmal atrial tachycardia.
A student going through drbeen’s EKG interpretation lectuers asked us the difference between MAT (multifocal atrial tachycardia) and PAT (paroxysmal atrial tachycardia).

Here is a quick summary of the differences:

1.  PAT is usually an extra focus/reentrant circuit in the atria. It is similar in pathology to PSVT but the location could be anywhere instead of near the coronary sinus (study our lecture on atrial flutter.) Due to the focus being away from the SA node, the P wave’s shape can be different but consistent. Usually, there also is a warm-up and cooling-down period.
2. MAT is due to many reentrant circuits (but not as many as in the atrial fibrillation). Because of multiple foci present in many locations in the atria, you will find P waves of many shapes. To diagnose a MAT you must identify three different shapes of the P waves in the EKG.

One more difference of the MAT and PAT from the PSVT is that carotid massage does not affect the heart rate in these conditions. Note: study this lecture to understand why it is difficult to cure arrhythmia due to reentrant circuits. (Hint: structural changes.)

MAT and PAT both have the common presentation of 100 to 200 bpm heart rate.

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