Focal atrial tachycardia (focal AT) is an organised atrial rhythm arising from a discrete origin and spreading centrifugally across both atria, in a patient who remains haemodynamically stable. This page addresses the situation where an initial treatment attempt has already been made and the tachycardia has not been terminated.
A first-line regimen — intravenous beta-blockers (esmolol or metoprolol) in the absence of decompensated heart failure, or intravenous verapamil or diltiazem in the absence of hypotension or HFrEF — did not achieve termination of the focal atrial tachycardia or adequate slowing of the ventricular rate. This next-line protocol is indicated when those goals were not met.
When the initial regimen has failed, the next step involves intravenous antiarrhythmic agents from specific drug classes. More than one option is available depending on the clinical context. The treatment goal remains termination of the atrial tachycardia. The complete sequence of options, selection criteria, and full details are available in the structured protocol.
DOI: 10.1093/eurheartj/ehz827
Focal AT is defined as an organized atrial rhythm ≥100 b.p.m. initiated from a discrete origin and spreading over both atria in a centrifugal pattern.
If the above measures fail, the following may be used: i.v. ibutilide; or i.v. flecainide or propafenone; or i.v. amiodarone.
Class IA, IC, and III drugs may also be effective, by prolonging refractoriness or suppressing automaticity.
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