ECG Quiz – Cardiology MCQ

Rhythm strip for diagnosis:

a) Atrial fibrillation
b) Sinus arrhythmia
c) Multifocal atrial tachycardia
d) None of the above
Correct answer: c) Multifocal atrial tachycardia
Multifocal atrial tachycardia is defined as three or more different types of P waves occurring at a rate more than 100 per minute.
The nearest differential diagnosis of a multifocal atrial tachycardia is atrial fibrillation (paroxysmal atrial fibrillation in this case). Multifocal atrial tachycardia (MAT) can occur in those with chronic obstructive lung disease [1].
Multifocal atrial tachycardia is sometimes called as chaotic atrial rhythm because of the variability in atrial activity. Ikaria study which evaluated the natural history of multifocal atrial rhythms in an elderly outpatient population showed that these rhythms are not associated with excess mortality in the elderly as in multifocal atrial tachycardias of hospitalised patients [2]. The study also showed that multifocal atrial rhythms have a high prevalence in the elderly (6%), with much higher prevalence in those above ninety years (15%).
Reference

1. Goudis CA, Konstantinidis AK, Ntalas IV, Korantzopoulos P. Electrocardiographic abnormalities and cardiac arrhythmias in chronic obstructive pulmonary disease. Int J Cardiol. 2015 Nov 15;199:264-73.
2. Lazaros G, Chrysohoou C, Oikonomou E, Tsiachris D, Mazaris S, Venieri E, Zisimos K, Zaromytidou M, Kariori M, Kioufis S, Pitsavos C, Stefanadis C. The natural history of multifocal atrial rhythms in elderly outpatients: insights from the “Ikaria study”. Ann Noninvasive Electrocardiol. 2014 Sep;19(5):483-9.