From the Guidelines
Atrial tachycardia treatment should prioritize intravenous beta blockers, diltiazem, or verapamil for acute management in hemodynamically stable patients, as recommended by the 2015 ACC/AHA/HRS guideline 1.
Acute Management
For acute termination of atrial tachycardia, the following options can be considered:
- Intravenous beta blockers, such as metoprolol, to control heart rate and reduce symptoms
- Calcium channel blockers like diltiazem or verapamil, which can also help control heart rate and reduce symptoms
- Synchronized cardioversion is recommended for patients with hemodynamically unstable focal atrial tachycardia 1
Long-term Management
For long-term management, the following options can be considered:
- Oral beta blockers, such as metoprolol, to control heart rate and reduce symptoms
- Calcium channel blockers, such as diltiazem, to control heart rate and reduce symptoms
- Class IC antiarrhythmics, such as flecainide, may be used for long-term management, but with caution and close monitoring, especially in patients with structural heart disease or left bundle branch block 1
- Catheter ablation offers a definitive treatment option for recurrent, symptomatic atrial tachycardia resistant to medications, with success rates exceeding 90%
Important Considerations
- Underlying causes, such as hyperthyroidism, electrolyte abnormalities, or structural heart disease, should be identified and addressed
- Anticoagulation therapy may be necessary for patients with risk factors for thromboembolism, following similar guidelines as for atrial fibrillation
- Treatment choice depends on tachycardia mechanism, patient symptoms, comorbidities, and preferences, with the goal of controlling symptoms and preventing tachycardia-induced cardiomyopathy 1
From the FDA Drug Label
In patients without structural heart disease, flecainide acetate tablets, USP are indicated for the prevention of: •paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia and other supraventricular tachycardias of unspecified mechanism associated with disabling symptoms •paroxysmal atrial fibrillation/flutter (PAF) associated with disabling symptoms
The treatment for atrial tachycardia may include flecainide acetate tablets, USP, as it is indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT), which includes atrial tachycardia. However, the use of flecainide acetate tablets, USP should be reserved for patients in whom the benefits of treatment outweigh the risks 2.
Alternatively, propafenone may also be considered for the treatment of paroxysmal supraventricular arrhythmias, including paroxysmal atrial fibrillation/flutter (PAF) and paroxysmal supraventricular tachycardia (PSVT) 3.
Key points:
- Flecainide acetate tablets, USP are indicated for the prevention of paroxysmal supraventricular tachycardias (PSVT).
- Propafenone is indicated for the treatment of paroxysmal supraventricular arrhythmias.
- The use of these medications should be reserved for patients in whom the benefits of treatment outweigh the risks.
From the Research
Atrial Tachycardia Treatment
- Atrial tachycardia is an uncommon arrhythmia that may be focal or macroreentrant 4.
- The treatment of atrial tachycardia has evolved over the years, with a shift from antiarrhythmic therapy to radiofrequency ablation due to the lack of efficacy of the former 4.
Rate Control in Atrial Fibrillation
- Rate control is an important component of the management of patients with atrial fibrillation (AF), and can be achieved using beta-blockers (BBs) or calcium channel blockers (CCBs) 5, 6, 7, 8.
- The choice of rate control medication depends on the patient's individual characteristics, including the presence of underlying heart disease and hemodynamic impairment 5.
- BBs and CCBs have been shown to be effective in reducing ventricular rate and improving symptoms in patients with AF 6, 7, 8.
- Studies have compared the efficacy of BBs and CCBs in rate control, with some showing that BBs may be more effective in reducing hospitalization duration 8.
Treatment Options
- Radiofrequency ablation is a treatment option for focal atrial tachycardia, and has been shown to be effective in eliminating the arrhythmia 4.
- Antiarrhythmic therapy may also be used to treat atrial tachycardia, although its efficacy is limited 4.
- The choice of treatment depends on the individual patient's characteristics and the severity of their symptoms 5, 4.
Comparison of Beta-Blockers and Calcium Channel Blockers
- Studies have compared the efficacy of BBs and CCBs in rate control, with some showing that BBs may be more effective in reducing hospitalization duration 8.
- BBs have been shown to decrease the heart rate more rapidly than CCBs, with a significant difference in the time to reach a target heart rate below 100 beats/min 8.
- CCBs and BBs have been shown to be equally safe and effective in reducing ventricular rate and improving symptoms in patients with AF 7.