Multifocal atrial tachycardia (MAT) presents a distinct management challenge characterised by a rapid, irregular rhythm with at least three distinct P-wave morphologies visible on the surface ECG. The primary clinical goal is control of the heart rate.
The defining feature of this sub-type is the presence of multiple ectopic atrial foci firing simultaneously, producing the characteristic irregular rhythm with morphologically varied P waves. Accurate recognition of this pattern on ECG is essential before selecting therapy.
Management is directed at controlling the heart rate by slowing conduction at the atrioventricular node level.
Acute rate control is achieved with intravenous agents — specifically, agents from one of two rate-slowing classes are used. The complete selection criteria, full agent list, dosing, and sequencing are available in the structured protocol below.
Multifocal AT is defined as a rapid, irregular rhythm with at least three distinct morphologies of P waves on the surface ECG.
i.v. beta-blockers, or i.v. non-dihydropyridine calcium channel blockers (verapamil or diltiazem) should be considered.
Management often involves slowing conduction at the AVN level to control heart rate.
DOI: 10.1093/eurheartj/ehz827
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