Atrial Tachycardia

Overview

What is atrial tachycardia?

Atrial tachycardia is a type of arrhythmia — an irregular heart rhythm — that causes the upper chambers of your heart to beat faster than normal. This condition has several possible causes but is usually not dangerous. It is often curable or manageable with medication.

Is this condition like atrial fibrillation?

Atrial tachycardia typically causes the heart's upper chambers to beat between 100 to 250 beats per minute in adults. However, this number can be higher in children and infants. While this is unusually fast, it doesn’t interfere with the heart’s normal pumping ability.

Atrial fibrillation is dangerous because it causes the heart's upper chambers to beat between 350 to 600 beats per minute. When this happens, your heart's upper chambers can't fill with blood and may not pump all of the blood already inside them, causing blood to pool. This can allow clots to form, and the clots can travel from your heart to your brain, causing a stroke.

Who does atrial tachycardia affect?

In general, atrial tachycardia can happen to anyone, and it tends to happen equally to men and women. However, certain types of atrial tachycardia are also more likely to happen at different ages.

How common is this condition?

Atrial tachycardia is fairly common, and it becomes more common as people get older. In general, there are approximately 90,000 new cases of paroxysmal (short-lived) atrial tachycardia per year in the United States. The more severe types of atrial tachycardia — atrial flutter and atrial fibrillation — affect about 2 million people in the United States.

Symptoms and Causes

What causes atrial tachycardia?

There are several potential causes for atrial tachycardia. Some of these include:

How does this condition work?

Your heart has four chambers. The lower chambers are the left and right ventricles. The upper chambers are the left atrium and right atrium (when you refer to both of them, the plural term is atria). Atrial tachycardia affects only the atria, causing them to beat too quickly.

Under normal conditions, each heartbeat starts with an electrical pulse that starts in a cluster of specialized cells. This is the sinoatrial (SA) node, the heart’s natural pacemaker, and it’s located in the right atrium. Next, electricity flows from the SA node to the rest of your heart. This cascade effect causes heart muscle cells to squeeze as the cascade passes through them.

Atrial tachycardia happens when the upper chambers of your heart squeeze faster than the lower chambers. A faulty electrical signal can cause this, or it might happen because the cells are malfunctioning. There are three ways that this usually happens.

Automaticity

While the SA node is your heart’s main pacemaker, there are backup pacemakers in your atria. These cells can take over and keep your heart beating if your SA node stops working, an ability called automaticity. When the SA node is working properly, it’s supposed to prevent automaticity from happening in these other backup pacemakers. When a backup pacemaker ignores that suppression and acts on its own, this is called enhanced automaticity. It can also happen when the SA node activates at the wrong time.

Heart muscle generates and conducts electricity by using chemical elements like sodium, potassium and calcium to create positive and negative charges. That’s how heart muscle cells can naturally react to an electrical pulse, but only if the pulse is strong enough. When the balance of the chemical elements isn’t right, the cells can react to a lower-than-normal electrical charge. This is called abnormal automaticity.

Atrial tachycardia caused by automaticity is more common in younger individuals.

Triggered activity

Sometimes, the cells may react to a pulse and then act again after the pulse has passed. This is called triggered activity. It can sometimes happen because of a chemical imbalance in the heart muscle cells. While this is similar to abnormal automaticity, there’s a key difference: The incorrect reaction has to follow a correct reaction to an electrical signal.

Reentry

Reentry happens when an electrical signal that tells the heart muscle to beat gets redirected and forms a circuit by crossing through the same cells more than once. The SA node can sometimes be part of this circuit (though this is rare). It can also happen with faulty activity from enhanced automaticity, as mentioned above. Reentry can happen in a very small area (micro-reentry), or it can happen over wider areas of the heart (macro-reentry).

Atrial tachycardia caused by micro-reentry is more common in older individuals.

What are the different types of atrial tachycardia?

Atrial tachycardia can be grouped into two types by the size of the area affected.

Focal. This kind of atrial tachycardia happens when the problem starts in a specific location on your heart. This problem location is called a focus. This type of atrial tachycardia is usually not dangerous, but it can be if it continues over a longer period.

  • There can be more than one focus in some cases, which is called multifocal atrial tachycardia. This type of atrial tachycardia can be easier to diagnose but may also be harder to treat. It's most commonly seen with COPD and as a toxic effect of digoxin.

Macro-reentrant. This type of atrial tachycardia works similar to reentry as described above but with some differences. A key feature of macro-reentrant atrial tachycardia is that the circuit happens over a wider area. It also usually happens because the signal has to travel around a part of the heart or an area of scar tissue before creating the circuit.

  • This type of atrial tachycardia can also cause atrial flutter. This is more severe than atrial tachycardia but not as severe as atrial fibrillation.

What are the symptoms of atrial tachycardia?

Atrial tachycardia can happen without symptoms, especially when it happens only for short periods. When it does cause symptoms in adults, these commonly include:

In infants and children, atrial tachycardia tends to cause the following symptoms:

  • Vomiting.
  • Feeding problems.
  • Rapid breathing.

How does atrial tachycardia affect my body?

Whether or not atrial tachycardia affects your body depends on how long the abnormal rhythm lasts. When it only lasts for short periods, it's not considered dangerous. However, when you have sustained atrial tachycardia, it can cause a problem called cardiomyopathy, which can weaken and damage your heart. If cardiomyopathy isn't treated, it can lead to heart failure and death.

Diagnosis and Tests

How is this condition diagnosed?

Atrial tachycardia can be diagnosed when a person has symptoms that indicate a heart rhythm problem. Diagnoses can also happen because of medical tests for other problems.

What tests will be done to diagnose atrial tachycardia?

The following tests are often used to diagnose atrial tachycardia.

  • Physical exam. This is the type of examination you get during most medical visits, especially an annual physical or wellness check. It’s also valuable because your provider may be able to hear a fast heart rhythm even if you have no other symptoms. Most providers will also go through your medical history to see if you have any risk factors that make this condition more likely.
  • Electrocardiography (ECG or EKG). This type of test measures the heart's electrical activity using sensors attached to the skin of your chest. It's done at a healthcare facility — such as a doctor’s office, clinic or hospital — and it usually takes just a matter of minutes.
  • Holter monitor. This is similar to an electrocardiogram but records heart activity over 1 to 2 days. You take this device home with you and return it after the set recording period ends.
  • Ambulatory monitors. These devices function like an electrocardiogram, but you take them home and wear them for an extended period (sometimes up to 30 days). Some monitors track your heart’s activity constantly but only record the data when you activate them because you feel symptoms. Others can activate themselves when they detect an abnormal rhythm. A clinician later reviews the recorded data after you return the device.
  • Electrophysiology study. This is a procedure that maps and measures the electrical activity of your heart. This can show areas where electrical activity in your heart isn’t happening as it should. Your healthcare provider then discusses that information with you so you can understand and decide how to treat the problem.

Management and Treatment

Can atrial tachycardia be cured?

Depending on the type, atrial tachycardia is often curable. When an underlying problem is the cause, treating the main disease can often cause atrial tachycardia to stop.

  • Focal atrial tachycardia: This type has a very high cure rate, especially with catheter-based techniques (see below for more info).
  • Multifocal atrial tachycardia: This is harder to cure because the problems start at different points in the heart. However, because it’s usually caused by other diseases, treating the underlying conditions can sometimes resolve multifocal atrial tachycardia or ease the symptoms.
  • Macro-reentrant atrial tachycardia: It’s often possible to cure this using catheter-based techniques. In rarer cases, the same type of procedure may use a surgical approach.

For those who don’t have symptoms and atrial tachycardia only lasts for short periods, your healthcare provider may recommend monitoring your condition only.

In some cases — especially cases where it only happens for short periods — atrial tachycardia can also go away on its own.

What medications are used?

Medications that are often used to treat atrial tachycardia include:

  • Beta blockers: This type of medication can stop or slow down certain cell functions, especially in your heart. These can be more effective at treating arrhythmias caused by automaticity or triggered activity.
  • Calcium channel blockers: These change the way your heart muscle cells use calcium. This can reduce how sensitive your heart muscle cells are to an electrical signal. These are also more effective with automaticity and triggered activity problems.
  • Other arrhythmia medications: Depending on what caused the arrhythmia in the first place, other anti-arrhythmia medications may help. Your healthcare provider can offer options based on the risks, benefits and possible side effects.

Another common way to treat atrial tachycardia is ablation. This is where certain areas of the heart are treated to stop them from improperly conducting electricity. This is very helpful at stopping focal atrial tachycardia and can also stop reentry problems by blocking part of a faulty electrical circuit.

Ablation can be done using the following methods:

  • Catheter ablation. These procedures start by inserting a device into a major blood vessel (usually near your groin). The device is then threaded up to your heart to treat the problem area. It can do this with either heat (radiofrequency ablation) or extreme cold (cryoablation). This type of procedure has a success rate of 90% or better.
  • Surgical ablation. For patients whose problem isn’t fixable with catheter ablation, it may also be possible to do it using surgery. Surgical approaches use similar methods but access the heart more directly through an incision in your chest.

How can I take care of myself and manage symptoms?

For people with atrial tachycardia, your healthcare provider can offer you guidance on what to do to care for yourself. In general, you should always do the following:

  • Follow up with your doctor as instructed. These follow-up visits can help track any lingering effects from the condition and spot signs that it has returned.
  • Take your medication. This is especially crucial for people whose atrial tachycardia can’t be easily cured or treated in other ways.
  • Manage your overall health. Diet and exercise all play a role in your heart health. Your healthcare provider can give you resources and guidance on how to eat right, keep moving and stay healthy in ways that are best for your heart.

How soon after treatment will I feel better?

Most people who undergo catheter-based procedures can go home that same day or the following day. However, for surgical procedures, the recovery time can take longer, possibly a few days. These procedures should stop your atrial tachycardia, but in some cases, it can return or other types of arrhythmias may happen.

For those who take medication for atrial tachycardia, your healthcare provider can tell you when you can expect to start feeling better. They’ll also schedule a follow-up visit to determine if the medication is helping or if changes are needed.

Prevention

How can I prevent atrial tachycardia?

In general, atrial tachycardia is unpredictable and isn’t preventable. However, it is possible to reduce your risk of developing it by avoiding or potential triggers. You can also try to prevent or delay developing conditions that can then cause atrial tachycardia.

How can I reduce my risk?

Doing the following can reduce your risk of developing atrial tachycardia:

  • Limit alcohol intake. Drinking too much alcohol is known to have negative effects on the heart. For men, limit your alcohol intake to two drinks per day and no more than 14 per week. For women, limit your intake two one drink per day and no more than seven per week. In some cases, your healthcare provider may advise you to consume even less. The above guidelines are general. Your healthcare provider can give you advice that better fits your specific needs and health.
  • Watch your consumption of stimulants. This includes caffeine and chocolate. You should also completely avoid recreational drugs like cocaine and methamphetamine and avoid abuse of prescription medications.
  • Quit tobacco. This includes all vape and smokeless tobacco products.
  • Manage your health with diet, exercise and weight management. This can help delay or prevent developing conditions like coronary artery disease.

Outlook / Prognosis

What can I expect if I have this condition?

Getting symptoms checked out early is important. This is because some of the symptoms also happen with more serious — possibly deadly — heart problems.

For most people, this condition only happens for short periods. It's not dangerous when it's short-lived, and you shouldn't experience any long-term problems from it. However, when it happens for long periods, it can cause problems if you wait too long to get medical care.

Fortunately, there are many different ways to treat atrial tachycardia, some of which can cure it completely. You can also keep it from returning or getting worse by avoiding things that cause it in the first place, like caffeine, recreational drugs, etc.

How long does atrial tachycardia last?

For some people, atrial tachycardia may go away on its own. For others, it may never return once it’s been cured using an ablation procedure. Unfortunately, there are some cases — especially those caused by another disease or condition —where it may become a life-long concern. For that last group, it can likely be treated with medication so that the symptoms are controlled or at least reduced.

Living With

When should I see my healthcare provider?

You should talk to your healthcare provider if your symptoms start to change. This includes if they get worse, happen more often or begin to disrupt your life. An example of this is feeling fatigued easily doing activities that didn't tire you out before.

When should I go to ER?

If you suddenly develop symptoms like shortness of breath, chest pain, or pass out for an unknown reason, you should get emergency medical care. That's because these atrial tachycardia symptoms also happen frequently with many more serious heart problems like heart attacks.

A note from Cleveland Clinic

Atrial tachycardia can cause symptoms that might cause you to feel afraid or anxious. However, it’s a condition that is often curable. When it can’t be cured, it’s often possible to manage it. When caught and treated early, it’s also unlikely to have any long-term negative effects. Talk to your healthcare provider about this condition and what they can do to help you. They can also provide you with resources that will help ease your mind. That way, you can focus on caring for yourself and taking action on this condition.

Last reviewed by a Cleveland Clinic medical professional on 09/27/2021.

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