Evidence supporting a new rate threshold for multifocal atrial tachycardia

Abstract

SummaryBackground: Exacerbation of chronic obstructive pulmonary disease (COPD) is overwhelmingly represented among patients presenting with multifocal atrial tachycardia (MAT) and has been used as a paradigm for such patients. The quasidiagnostic tachycardia threshold for MAT is conventionally set at 100 beats/min. Nevertheless, this threshold has not been demonstrated to be optimal.Hypothesis: Using COPD as a paradigm for MAT, clinical experience led to the hypothesis that MAT with a tachycardia threshold < 100 beats/min could be more closely associated with COPD exacerbation. Methods and Results:We reviewed 60 consecutive patients with multifocal atrial arrhythmia (MAA) at any heart rate and found a better association between the incidence of COPD exacerbations and MAT using a tachycardia threshold of 90 beats/min (p = 0.00036) than when using a threshold of 100 beats/min (p = 0.515). Conclusion:The rate threshold of MAT should be reduced from 100 to 90 beats/min.

Anesthesia for patients with severe chronic obstructive pulmonary disease

“…The delivered medication may become absorbed systemically and increase the risk of cardiac arrhythmias due to sympathetic stimulation. Patients with COPD are at enhanced risk of developing atrial arrhythmias such as multifocal tachycardia [35,36], which may lead to atrial fibrillation. Levalbuterol, the left-turning enantiomer of albuterol, is thought to produce less tachyarrhythmias based on limited evidence.…”

The Natural History of Multifocal Atrial Rhythms in Elderly Outpatients: Insights from the “Ikaria Study”

“…8 For heart rates ࣙ90 and ࣘ60 bpm, the terms multifocal atrial tachycardia and bradycardia, respectively, were adopted, whereas those with heart rate between 60 and 90 bpm were diagnosed with chaotic atrial rhythm. 9,10 Patients with MARs were monitored for at least 5 minutes so as to ensure that the underlying rhythm was continuous and not intermittent. As in other similar works including this one, atrial fibrillation and flutter (which on a pathophysiological basis constitute multifocal atrial arrhythmias) were not included in the definition of MARs.…”

Physical Diagnosis of Chronic Obstructive Pulmonary Disease

“…Severe hypoxia or hypercapnia can cause arrhythmia such as multi-atrial tachycardia, atrial fibrillation or ventricular tachycardia (52,53).…”