Schwartz M, Rodman D, Lowenstein S R
Division of Pulmonary Sciences, University of Colorado Health Sciences Center, Denver 80262.
J Emerg Med. 1994 May-Jun;12(3):353-60. doi: 10.1016/0736-4679(94)90278-x.
Multifocal atrial tachycardia (MAT) is an uncommon but clinically important tachydysrhythmia that is usually seen in the setting of severe cardiopulmonary illness. Diagnostic criteria include the presence of at least three different, nonsinus P waves in the same lead; an atrial rate greater than 100 beats per minute; and an isoelectric baseline between P waves. MAT is often difficult to differentiate from atrial fibrillation. The pathogenesis of MAT is unknown; however, it is probably incited by "triggered" electrical activity, a form of abnormal automaticity. This electrophysiologic model has led to several small, uncontrolled clinical trials using calcium channel and beta-adrenergic blocking agents, specifically verapamil and metropolol. None of these trials meets rigorous methodologic standards, and all exclude unstable patients who are at greatest risk for hemodynamic compromise from the tachycardia. Treatment of MAT should first be directed at potential predisposing factors, such as hypoxia, congestive heart failure, and theophylline toxicity. Pharmacologic treatment includes intravenous metoprolol or verapamil; in published reports both agents have been well tolerated and have controlled the heart rate in a majority of patients.
多源性房性心动过速（MAT）是一种不常见但临床上重要的快速性心律失常，通常见于严重心肺疾病患者。诊断标准包括在同一导联中至少存在三种不同的非窦性P波；心房率大于每分钟100次；P波之间有等电位基线。MAT常难以与心房颤动相鉴别。MAT的发病机制尚不清楚；然而，它可能是由“触发”电活动引起的，这是一种异常自律性形式。这种电生理模型促使了几项使用钙通道阻滞剂和β肾上腺素能阻滞剂（特别是维拉帕米和美托洛尔）的小型、非对照临床试验。这些试验均未达到严格的方法学标准，并且都将因心动过速而最易发生血流动力学损害的不稳定患者排除在外。MAT的治疗应首先针对潜在的诱发因素，如缺氧、充血性心力衰竭和茶碱中毒。药物治疗包括静脉注射美托洛尔或维拉帕米；在已发表的报告中，这两种药物耐受性良好，并且在大多数患者中都能控制心率。
