Multifocal Atrial Rhythm

A pt with h/o of HTN and COPD. What is the rhythm?

Figure 1 - ECG case

 

This is an irregular rhythm with different P wave morphologies, variable PR intervals and irregular P-P intervals. This is multifocal atrial rhythm/multifocal atrial tachycardia (MAR for rates < 100 and MAT for rates >100). MAT is also called chaotic atrial tachycardia.

Patient eventually converted to atrial fibrillation with rapid ventricular response (AF with RVR). 

MAT commonly occurs in older patients with COPD and CHF. MAR/MAT often is mislabeled as atrial fibrillation or wandering atrial pacemaker (WAP).

 

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