Irregularly irregular rhythm with varying PP, PR and RR intervals


*Heart rate > 100 bpm (usually 100-150 bpm; may be as high as 250 bpm).
*Irregularly irregular rhythm with varying PP, PR and RR intervals.
*At least 3 distinct P-wave morphologies in the same lead.
*Isoelectric baseline between P-waves (i.e. no flutter waves).
*Absence of a single dominant atrial pacemaker (i.e. not just sinus rhythm with frequent PACs).
*Some P waves may be nonconducted; others may be aberrantly conducted to the ventricles.
*Decompensated chronic lung disease
*Coronary artery disease
*Heart failure
*Valvular heart disease
*Diabetes mellitus
*Postoperative state
*Pulmonary embolism
*Methylxanthine toxicity
*Usually occurs in seriously ill elderly patients with respiratory failure (e.g. exacerbation of COPD / CHF).
*Tends to resolve following treatment of the underlying disorder.
*The development of MAT during an acute illness is a poor prognostic sign, *associated with a 60% in-hospital mortality and mean survival of just over a year. Death occurs due to the underlying illness; not the arrhythmia itself.
Potential acute complications of MAT include the following:
*Atrial thrombi with embolization and subsequent #stroke
*Myocardial infarction from incongruous myocardial supply and demand
*Pulmonary emboli