TABLE 6

Recommendations for Treatment of Focal Atrial Tachycardia

Clinical SituationRecommendationClassificationLevel of EvidenceReferences
Acute treatment
 A.Conversion
 Hemodynamically unstable patientDC cardioversionIB
 Hemodynamically stable patientAdenosineIIaC123,130
Beta blockersIIaC131,132
Verapamil, diltiazemIIaC114,133
ProcainamideIIaC
Flecainide/propafenoneIIaC133–136
Amiodarone, sotalolIIaC116,135,137–140
 B.Rate regulation (in absence of digitalis therapy)Beta blockersIC131,132
Verapamil, diltiazemIC141
DigoxinIIbC
Prophylactic therapy
 Recurrent symptomatic ATCatheter ablationIB124
Beta blockers, calcium-channel blockersIC
DisopyramideIIaC138
Flecainide/propafenoneIIaC133,135,136,142,143
Sotalol, amiodaroneIIaC116,137–139
 Asymptomatic or symptomatic incessant AtsCatheter ablationIB
 Nonsustained and asymptomaticNo therapyIC
Catheter ablationIIIC

The order in which treatment recommendations appear in this table within each class of recommendation does not necessarily reflect a preferred sequence of administration. Please refer to text for details. For pertinent drug dosing information please refer to the ACC/AHA/ESC Guidelines on the Management of Patients With Atrial Fibrillation.

AT indicates atrial tachycardia; DC, direct current; MAT, multifocal atrial tachycardia.

  • Excluded are patients with MAT in whom beta blockers and sotalol are often contraindicated due to pulmonary disease.

  • All listed drugs for acute treatment are administered intravenously.

  • Flecainide, propafenone, and disopyramide should not be used unless they are combined with an AV-nodal-blocking agent.