Intra-atrial re-entry tachycardia involves a circuit in the atrium and does not involve the atrioventricular node. Like paroxysmal atrial tachycardia, it is frequently initiated by an atrial premature contraction, establishing the re-entry circuit. QRS morphology is the same as seen in sinus rhythm; however, the P wave has a different morphology. As with other re-entry arrhythmias, onset and termination are sudden, but carotid sinus massage will not cause termination since neither sinoatrial nor atrioventricular nodes are involved.
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