Hrev_master


[page 42]                                                       [Emergency Care Journal 2015; 11:5148]

Classical warm up phenomenon
of atrial tachycardia
Amjad Ali, Cholenahally N. Manjunath
Institute of Cardiovascular Sciences and
Research, Bengaluru, India

The joint expert group defined focal atrial
tachycardia as being characterized by atrial
activation starting rhythmically at a small area
(focus) from where it spreads centrifugally.1

Here we report a 55-year-old male patient pre-
sented with paroxysmal palpitation: his 12-
leads electrocardiogram (ECG) was suggestive
of paroxysmal irregular narrow complex tachy-
cardia, which spontaneously reverted to nor-
mal sinus rhythm (Figure 1). On initiation,
tachycardia typically exhibits a warm up phe-
nomenon during which atrial rate gradually
accelerates after its initiation and slows prior
to termination.2 On first sight, ECG looked like
atrial fibrillation because of its irregular
rhythm, but this ECG nicely depicted a warm
up phenomenon of automatic atrial tachycar-
dia, which had a diagnostic value in this case.
The slight difference in terms of RR cycles can
also be seen in atrio-ventricular nodal reen-

trant tachycardia, and it has been attributed to
a model of a figure-of-8-reentry, continuously
crossing over the antegrade activation through
an inferior input to the controlateral superior
input via the atrioventricular  node.3,4

Differentiation of narrow complex tachycardia
on the basis of 12-leads ECG is difficult and
requires further electrophysiological studies or
pacing maneuvers. 

References

1. Saudi N, Cosio F, Waldo A, et al.
Classification of atrial flutter and regular
AT according to electrophysiology mecha-
nism and anatomic base: a statement from
a joint expert group from the Working
Group of Arrhythmias of the European
Society of Cardiology and the North
American Society of Pacing and
Electrophysiology. J Cardiovasc Electr
2000;12:852-66.

2. Chen SA, Cluang CE, Yang CJ, et al.
Sustained atrial tachycardia in adult
patient electrophysiological characteris-
tics. Pharmacological response, possible
mechanism and effects of radiofrequency

ablation. Circulation 1990:1262-78.
3. Katritsis DG, Camm AJ. Classification and

differential diagnosis of atrioventricular
nodal re-entrant tachycardia. Europace
2006;8:29-36.

4. Katritsis DG, Becker A. The circuit of atri-
oventricular nodal reentrant tachycardia: a
proposal. Heart Rhythm 2007;4:1354-60.

                             Emergency Care Journal 2015; volume 11:5148

Correspondence: Amjad Ali, Institute of
Cardiovascular Sciences and Research,
Bannerghatta Road, 560069 Bengaluru, India.
Tel: +91.80.2297.7281.
E-mail: drmz2007@gmail.com

Key words: Warm up; Atrial tachycardia; ECG.

Received for publication: 11 March 2015.
Revision received: 11 April 2015.
Accepted for publication: 27 April 2015.

This work is licensed under a Creative Commons
Attribution 3.0 License (by-nc 3.0).

©Copyright A. Ali and C.N. Manjunath, 2015
Licensee PAGEPress, Italy
Emergency Care Journal 2015; 11:5148
doi:10.4081/ecj.2015.5148

Figure 1. Electrocardiogram suggesting paroxysmal irregular narrow complex tachycardia.

Non
 co

mmerc
ial

 us
e o

nly