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Multifocal atrial tachycardia

Image 2 of 3 in Series "Multifocal Atrial Tachycardia"


A few hours after her pancreatectomy, an irregular narrow complex tachycardia occurred. On closer inspection, there are buried P waves of more than three morphologies and rate-dependent ST-depressions in the inferior leads (II, III, and aVF) and from V4-V6.

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This image is part of the series "Multifocal Atrial Tachycardia"

Other images in this series

Normal sinus rhythm at baseline

by: Raymond Mai, DO

Baseline ECG three months prior to the patient's elective pancreatectomy. Normal sinus rhythm, normal axis, diffuse non-specific ST-T wave flattening.

Wandering atrial pacemaker

by: Raymond Mai, DO

The patient was given metoprolol tartrate 5mg IV push in order to slow the heart rate. This resulted in a wandering atrial pacemaker with more than 3 P wave morphologies and a resolution of the rate-dependent ST-depressions seen while in MAT. Looking at lead II, there is a bifid P waves also known as P mitrale which is indicative of left atrial enlargement. Echocardiogram later revealed a mildly dilated left atrium.