Arrhythmias
Atrial tachycardia AT
Atrial tachycardia is a fast heart rhythm that starts in the atria, the two upper chambers of the heart. An electrical signal emerges from another section of the atria and causes a rapid repeating beat, which means the atria beat very fast. It is one form of supraventricular tachycardia, or SVT, and short bouts of it can be common.
What atrial tachycardia is
Your heart relies on a precise electrical system to control each heartbeat. Signals normally begin in a small structure called the sinus node, often referred to as the heart's natural pacemaker, and travel through specialised pathways in the heart muscle so that the chambers contract in a coordinated sequence.
In atrial tachycardia, an electrical signal emerges from another section of the atria and causes a rapid repeating beat, which means the atria beat very fast. Because that signal starts above the ventricles, atrial tachycardia belongs to the group of rhythms known as supraventricular tachycardias. An SVT is a fast heart rhythm that originates above the ventricles, but not always in the same way as an atrial tachycardia.
In adults, a resting heart rate above 100 beats per minute is generally considered tachycardia. The atria are the chambers that receive blood into the heart before it is pumped by the lower chambers to either the lungs or the rest of the body.
What happens during an episode
Short bouts of SVTs or atrial tachycardias can be common, and can usually be treated very easily.
Atrial tachycardias can be more worrying if they continue for a long period, because the rapid signals may be transmitted to the ventricles, so the heart would beat too fast and blood would not be pumped around the body effectively.
This is why Dr Jogiya will usually want to know how long your episodes last, how often they happen and what you feel while they are going on.
Symptoms you may notice
Symptoms for SVTs vary widely from one person to another. Some people feel an episode very clearly, while others notice very little, and atrial arrhythmias in general can cause a wide range of symptoms.
The ones people most often describe are listed below.
Palpitations are a symptom rather than a diagnosis, and the underlying cause can vary widely. The pattern of your symptoms, how they feel and when they occur all help to work out whether they are harmless or need further investigation.
- Palpitations, which people describe as a rapid pounding in the chest, a fluttering sensation, or the impression that the heart has skipped a beat
- Shortness of breath
- Dizziness
What can set an episode off
Rhythm disturbances sometimes occur in otherwise healthy hearts, triggered by everyday factors rather than by heart disease. The triggers below are the ones described for palpitations and heart rhythm disturbances in general, rather than proven causes of atrial tachycardia specifically.
These factors can increase adrenaline levels or affect the heart's electrical activity, leading to temporary changes in rhythm. In other cases arrhythmias develop alongside an underlying heart condition, and electrolyte imbalances, thyroid disorders and certain medications can also affect the heart's electrical activity. Understanding the underlying cause helps guide treatment decisions.
- Stress or anxiety
- Caffeine intake
- Poor sleep
- Dehydration
- Alcohol
How atrial tachycardia is diagnosed
The diagnosis of heart rhythm issues is usually done through an ECG, or a Holter monitor, which is a prolonged ECG recording, to get an understanding of the heart rhythm.
The most important step is to capture what the heart is doing during an episode. One practical challenge is that an atrial tachycardia may not occur during a short clinic visit, which is where longer monitoring becomes particularly valuable. Wearable technology and remote monitoring are also helping to detect irregular rhythms earlier. Dr Jogiya will usually arrange one or more of the following.
Once treatment is under way, regular ECGs will be conducted to ensure that treatments are successful and effective.
- A 12 lead ECG to record the electrical activity of the heart
- Holter monitoring worn continuously over 24 to 48 hours or longer
- Event monitors and longer term wearable monitors that capture intermittent symptoms
- An echocardiogram to assess the structure of the heart
How atrial tachycardia is treated
Treatment options are personalised to the patient and the symptoms they experience.
Vagal manoeuvres such as coughing or an ice pack on the face can stimulate the vagus nerve, and this often relaxes and resolves the atrial tachycardia. They are not something to try on the strength of a web page. Dr Jogiya will tell you whether any of them are suitable for you, and how to do them, before you use them yourself.
Medication is another way to manage the condition, with beta-blockers or calcium channel blockers used to control it. Whether medication is needed at all, and which one, is a decision for a consultation, and Dr Jogiya will discuss what suits your rhythm, your symptoms and your general health.
Where episodes keep returning or prove harder to control, the treatments used across this wider family of supraventricular rhythms may be considered. These include an electrophysiology study, DC cardioversion and ablation procedures. Whether any of them applies to your own rhythm is something Dr Jogiya will talk through with you.
When to seek help
Call 999 immediately if you have chest pain, if you collapse or lose consciousness, or if you notice the signs of a stroke such as a drooping face, weakness in one arm or slurred speech. Do not wait to see whether the episode settles on its own, and do not wait for an appointment.
If none of those emergency signs are present, it is still always reasonable to seek advice when you are unsure about your symptoms. An assessment is worth arranging in the following situations.
Early evaluation provides reassurance when the cause is harmless and allows timely treatment when it is needed. This page is general information about atrial tachycardia and is not a substitute for a consultation about your own heart.
- Palpitations are frequent or getting worse
- They occur alongside dizziness, fainting or breathlessness
- They are associated with chest discomfort
- They happen during physical exertion
- They last for prolonged periods
- You already have a known heart condition
- The episodes feel different from anything you have experienced before
Where the figures on this page come from
Every figure above is quoted from one of these. This page is general information, not individual medical advice.
More in arrhythmias
Related conditions he treats.
- Atrial fibrillationAtrial fibrillation, commonly known as AF, is a condition where the atria, or upper chambers of the heart, fire chaotic electrical impulses. This leads the muscle to quiver, or fibrillate, instead of beat, so the heartbeat becomes irregular and is often faster than normal. It is one of the most common heart rhythm issues and around 1.7 million people in the UK have been diagnosed with it.
- Atrial flutterAtrial flutter is a heart rhythm problem that affects the upper chambers of the heart, known as the atria. Instead of beating at a normal pace, the atria beat rapidly, but in a regular and organised pattern rather than a chaotic one. Because the chambers do not have enough time to fill properly, blood is not pumped efficiently from the top chambers to the bottom chambers, which is what leads to shortness of breath.
- Bundle branch blockBundle branch block describes a block in the part of the heart's conduction system known as the bundle branches. These branches carry the electrical impulse from the AV node down to each ventricle, and when one of them is blocked the signal reaches one side of the heart before the other, so the two ventricles no longer contract in step. It is a pattern picked up on an ECG, and mostly it is something monitored rather than actively treated.
- First degree heart blockFirst degree heart block is common, and it can affect anyone at any age. It describes a delay in the electrical signal as it travels from the upper chambers of the heart to the lower chambers, rather than a true blockage. Every signal still gets through, which is why many people notice nothing at all and why the condition is usually diagnosed when testing is being done for something else.
- Second degree heart blockSecond degree heart block is a fault in the heart's electrical wiring, not a blockage in an artery. Some of the electrical signals travelling from the upper chambers of the heart fail to reach the lower chambers, so a heartbeat is occasionally missed. There are two types, known as Mobitz I and Mobitz II, and they are treated very differently.
- Sick sinus syndromeSick sinus syndrome, also called sinus node disease, is a condition where the sinus node, the small area of tissue that acts as the heart's own natural pacemaker, is not functioning properly. Sometimes the node will send an impulse as it should, and sometimes it may not fire an impulse at all, or the impulses may be out of sync. Some patients notice symptoms such as palpitations and shortness of breath, and because the node is unreliable rather than permanently stopped, those symptoms often come and go.
- Supraventricular tachycardiaSupraventricular tachycardia, usually shortened to SVT, is a fast heart rhythm that starts above the ventricles, in the upper part of the heart. Symptoms vary widely from one person to another, so some people are very aware of an episode while others barely notice one. Short bouts of SVT can be common, and can usually be treated very easily.
- Tachy brady syndromeTachy brady syndrome is a heart rhythm problem in which the heart rate increases and then decreases spontaneously, without any external influence. Instead of settling at a pace that matches what you are doing, the heart swings between periods of a slow rate and sudden bursts of a fast one. It is closely linked to sinus node disease, and it occurs mostly alongside atrial fibrillation.