What is the management of isolated prolonged atrial (apt) tachycardia?

From the Guidelines

Management of isolated prolonged atrial tachycardia (AT) should prioritize catheter ablation as a first-line treatment option, especially in symptomatic patients, due to its high success rate and low complication risk, as recommended by the 2015 ACC/AHA/HRS guideline 1.

Key Considerations

• The decision to proceed with catheter ablation should be based on the patient's symptoms, quality of life, and the presence of any underlying heart disease.
• Before proceeding with catheter ablation, it is essential to rule out any reversible causes of AT, such as electrolyte imbalances or drug-induced effects.
• The use of oral beta blockers, diltiazem, or verapamil may be considered for ongoing management in patients with symptomatic focal AT, as they are moderately effective in controlling symptoms, as stated in the 2015 ACC/AHA/HRS guideline 1.

Treatment Options

• Catheter ablation: This is a highly effective treatment option for focal AT, with success rates above 90% in experienced centers, and a low complication rate of <1% to 2%, as reported in the 2015 ACC/AHA/HRS guideline 1.
• Oral beta blockers, diltiazem, or verapamil: These medications can be used for ongoing management in patients with symptomatic focal AT, as they are moderately effective in controlling symptoms, as stated in the 2015 ACC/AHA/HRS guideline 1.
• Flecainide or propafenone: These medications may be effective for ongoing management in patients without structural heart disease or ischemic heart disease who have focal AT, as reported in the 2015 ACC/AHA/HRS guideline 1.

Important Considerations

• The management of isolated prolonged AT should prioritize the patient's quality of life and symptoms, rather than just the presence of the arrhythmia itself.
• A multidisciplinary approach, involving cardiologists, electrophysiologists, and other healthcare professionals, is essential for optimal management of patients with AT.
• The use of anticoagulants, such as warfarin or direct oral anticoagulants (DOACs), may be necessary in patients with AT who are at high risk of thromboembolism, as recommended by the 2024 ESC guidelines for the management of atrial fibrillation 1.

From the Research

Management of Isolated Prolonged Activated Partial Thromboplastin Time (APTT)

• Isolated prolonged APTT is a common inquiry in coagulation laboratories, where the prothrombin time (PT) and/or international normalized ratio (INR) are normal 2
• This finding can lead to diagnostic dilemmas, particularly when surgery needs to be postponed until the cause of the isolated prolonged APTT is established 2, 3
• Causes of isolated prolonged APTT include:
  • Lupus anticoagulants 2, 4
  • Anticoagulant treatment, mainly heparin 2
  • Deficiencies of specific coagulation factors, such as factors V, VIII, and X 2, 5
• A practical diagnostic algorithm can be used to differentiate between lupus anticoagulants and factor deficiencies 2, 3, 4
• Preanalytical factors, such as storage conditions of plasma, can impact APTT results, and exclusion of preanalytical error is the first step in the diagnostic process 3, 5
• The identification of the underlying cause of isolated prolonged APTT is crucial for ensuring correct therapeutic follow-up 2, 6