What Is Paroxysmal Atrial
Paroxysmal atrial tachycardia is a type of arrhythmia (irregular
heartbeat). Paroxysmal means
that the episode of arrhythmia begins and ends abruptly. Atrial means
that arrhythmia starts in the atria or upper chambers of your heart. Tachycardia means
that the heart is beating abnormally fast. Paroxysmal atrial tachycardia (PAT)
is also known as paroxysmal supraventricular tachycardia (PSVT).
Other types of tachycardia that start in the atria include atrial
fibrillation, atrial flutter, and Wolff-Parkinson-White syndrome.
PAT can cause an adult’s heart rate to increase from between 60 and
100 beats per minute to between 130 and 230 beats per minute. Infants and
children normally have higher heart rates than adults, with between 100 and 130
beats per minute. When an infant or child has PAT, their heart rate will be
greater than 220 beats per minute. PAT is the most common form of tachycardia
in infants and children.
In most cases this condition isn’t life-threatening. However, it’s
uncomfortable and can be alarming. In rare instances, some people with
Wolff-Parkinson-White syndrome may develop an extremely rapid heart rate that
What Are the Causes of PAT?
PAT occurs when electrical signals starting in the heart’s upper
chambers (atria) fire irregularly. This affects the electrical signals transmitted
from the sinoatrial node, which is your heart’s natural pacemaker. This speeds
up your heart rate and prevents your heart from having enough time to fill with
blood before pumping blood out to the rest of the body. This means that your
body may not receive enough blood or oxygen.
Who Is at Risk for PAT?
Women are at a higher risk for PAT than men.
Your emotional health can affect your risk for PAT. If you’re physically
exhausted or have anxiety, then you’re at high risk for the condition. In
addition, if you drink excessive amounts of caffeine or drink alcohol daily,
your risk for PAT goes up.
Having other heart issues such as a history of heart attacks or
mitral valve disease may increase your risk. Children suffering from congenital
heart disease are at a high risk for PAT.
What Are the Symptoms of
Some people don’t experience signs or symptoms of PAT, while
others may notice:
(increased heart rate)
(pains in the chest)
In rare cases, PAT may cause:
How Is PAT Diagnosed?
Your doctor may recommend an electrocardiogram (ECG) test to help
diagnose PAT. An ECG test measures the electrical activity in your heart. Your
doctor will ask you to lie down and will then attach a number of electrodes to
your chest, arms, and legs. You will need to remain still and hold your breath
for just a few seconds. It’s important to try to stay still and relaxed, as
even a slight movement can affect the results.
The electrodes attach to wires that transmit your heart’s
electrical activity to a machine that prints them out as a series of wavy
lines. Your doctor will examine this data to determine if you have a heart rate
that’s higher than normal or has an irregular rhythm.
You may also undergo this test during a period of light exercise
or activity to measure the changes in your heart under stress.
Your doctor may also want to test your blood pressure.
It can be difficult to catch your episode of PAT, so your doctor
may also want to have you wear a Holter monitor. Two or three electrodes will
be applied to your chest, similar to the ECG. You will wear the device for 24
to 48 hours (or more) while you do your normal daily activities, and then
return it to the doctor. The device will record any fast heartbeats that may occur
during the time you are wearing it.
What Are the Treatments for
Most people with PAT don’t ever require treatment for their
condition. However, your doctor may recommend treatment or medications if your
episodes occur frequently or last for a considerable length of time.
Vagal maneuvers stimulate your vagus nerve to slow your heart
rate. Your doctor may suggest using one of the following vagal maneuvers during
an episode of PAT:
sinus massage (applying gentle pressure to your neck where your carotid artery
gentle pressure to the closed eyelids
maneuver (pressing your nostrils together while exhaling through your nose)
reflex (suddenly immersing your face or body in cool water)
If you frequently experience episodes of PAT and the maneuvers
outlined above don’t restore your normal heart rate, your doctor may prescribe
medication. Your doctor may give you an injection of flecainide (Tambocor) or
propafenone (Rythmol) to slow your heart rate. Your doctor may also prescribe
one of those medications in pill form that you can take during a future episode
Your doctor may recommend that you reduce your intake of caffeine
and alcohol, and stop or reduce your use of tobacco. They’ll also want to
ensure that you’re getting plenty of rest.
In rare and extreme cases, your doctor may suggest catheter
ablation. This is a nonsurgical procedure that removes heart tissue in the area
of the heart that’s causing the increased heart rate. During the procedure,
your doctor will place a catheter against the trigger area. They will transmit
radio-frequency energy through the catheter to produce enough heat to destroy
the precise trigger area.
What Complications Are
Associated with PAT?
Complications of PAT vary with the rate and duration of the
abnormally fast heartbeat. Complications also vary based on whether you have an
underlying heart condition. Some people with PAT may be at risk for blood clots
that could result in a heart attack or a stroke. In those cases, doctors
usually prescribe medications like dabigatran (Pradaxa) or warfarin (Coumadin),
which thin the blood and reduce the risk for blood clots.
In rare cases, complications may include congestive heart failure
How Can I Prevent PAT?
The best way to prevent PAT is to avoid smoking and limit
drinking alcohol and caffeinated beverages. Getting regular exercise and plenty
of rest is also advised. By maintaining a healthy diet and lifestyle and
keeping your weight in a healthy range, you can also significantly reduce your
risk of PAT.
What Is the Long-Term
PAT is not a life-threatening condition. The periods of sudden
rapid heartbeat are much more uncomfortable than they are dangerous. The
outlook for someone who has PAT is generally positive.