Multifocal tachycardia is a very rapid irregular rhythm that can be difficult to differentiate from atrial fibrillation. Finding the P wave is very helpful as this rhythm is associated with distinct P waves that vary in morphology (Fig, 4). As with non-paroxysmal atrial tachycardia, the rate is usually 110 to 130 beats/min and is due to enhanced automaticity. It also has the same precipitating factors (e.g. pulmonary disease, hypoxemia, heart failure, acidosis, and theophylline toxicity).
Fig. 4 Multifocal atrial tachycardia. Notice P waves of different morphology.
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