Careful analysis of P wave morphology during tachycardia onset can differentiate ectopic atrial tachycardia with a warm-up period from multifocal atrial tachycardia.
Urges P-wave scrutiny at onset in suspected MAT; extends differentiation of EAT from multifocal atrial tachycardia.
The above electrocardiogram (EKG) was recorded in a young patient with abdominal pain and palpitations. At first glance the P wave morphology appears to vary, with greater than 3 different morphologies identified as indicated by the different color arrows, suggestive of multifocal atrial tachycardia at 102 beats/minute (BPM). A closer look, however, reveals an initial sinus rhythm (first 2 beats, light green arrows) followed by what seems to be gradual fusion of sinus P waves with ectopic atrial P waves (dark green and light brown arrows), likely a “warm-up period”, with subsequent complete usurpation of the sinus rhythm by an ectopic atrial tachycardia (red arrows).
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Qureshi et al. (2025) studied this question.
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