Paroxysmal atrial tachycardia (PAT) is a sudden irregular heartbeat that can be caused by extra heart tissue or an abnormality in the atrial node. It can be diagnosed with an event monitor or Holter monitor and may be treated with medication, cardiac ablation, or a defibrillator. PAT can be life-threatening for those who have had corrective heart surgery, especially the Fontan operation.
Paroxysmal atrial tachycardia (PAT) is a condition in which the upper chambers of the heart, the atria, begin to beat irregularly, sometimes producing heartbeats as fast as 200-220 beats per minute (bpm). The condition is called paroxysmal, as it occurs suddenly and without warning. In people without abnormal heart conditions, this is not usually considered a dangerous arrhythmia, but in people who have had corrective heart surgery, especially the Fontan operation, it can be life-threatening.
There are a few potential causes of PAT. Some people have extra heart tissue that acts as an extra conductor, occasionally causing the heart to make rapid beats. This is called Wolff Parkinson White (WPW) syndrome. In other cases, there is a small abnormality in the atrial node, creating the occasional heartbeat or palpitations. Other times, the condition can be induced by people who are alcoholics or those who consume excess caffeine. Women who menstruate may also experience palpitations.
Paroxysmal atrial tachycardia is difficult to diagnose because it doesn’t always happen. Unless you’re doing an ECG on a person as it’s happening, you won’t necessarily see anything abnormal about the heart rhythm. If a person is experiencing palpitations, what usually happens is that he or she is wearing what is called a cardiac event monitor. If they begin to experience a rapid heartbeat, they press a button, which records the “event” via several probes attached to their chests. An event monitor can be worn for several weeks in order to capture PAT episodes. Alternatively, if symptoms occur frequently, a 24-hour Holter monitor can be used to detect fast and extra beats.
Symptoms of paroxysmal atrial tachycardia can last from a few minutes to several hours. When the rapid heartbeat remains for more than a minute or two, a person may feel breathless, have chest pain, dizziness, have a panic attack, or pass out. It is a frightening thing to endure several hours of this condition, even when it does not cause pain or fainting. Dizziness and fainting can be caused by the atrial chambers not being able to fill completely, thus leading to an inadequate blood supply to the body and lungs. While this is rarely life threatening, with children who have had surgeries like Fontan, it can result in sudden death.
If paroxysmal atrial tachycardia occurs infrequently, the condition may not be treated. Instead, doctors may suggest avoiding caffeinated beverages and keeping a log of events. When it occurs often, doctors look for the cause and ways to treat it. Where WPW exists, doctors called electrophysiologists will perform a cardiac ablation, a nonsurgical procedure done via catheterization that essentially destroys excess tissue by sending false signals to the heart to make it beat too rapidly. In many cases, people may require medications when PAT occurs frequently and WPW is not present.
When paroxysmal atrial tachycardia does not respond to medications, cardiac ablation may be tried or patients may be implanted with a defibrillator (similar to a pacemaker), which helps control and regulate heart rhythms. Patients who have had Fontan are most likely to have this method of treatment, as the rapid heart rate can be life-threatening for them.
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