Multifocal Atrial Tachycardia

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Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →
  1. Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
  2. Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
  3. Set mode Demand (synchronous), rate 60–80/min.
  4. Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
  5. Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
  6. Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
  7. Bridge to transvenous pacing or treat underlying cause.
ANTERIORANTPOSTERIORPOSTSandwich the heart between pads
A–P pad placement

Rhythm strip

Source ↗
≥3 P-wave morphologiesIrregular R–RAtrial rate >100
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  • ≥ 3 distinct P-wave morphologies in same lead
  • Varying PR, PP, and RR intervals
  • Atrial rate > 100 (often in severe COPD)
Recognition
  • Atrial rate > 100
  • ≥ 3 distinct P-wave morphologies in same lead
  • Varying PR, PP, and RR intervals
  • Strongly associated with severe COPD and hypoxia
Management
Treat the underlying cause
  • (Mg 2 g IV common)
Rate control if symptomatic
  • (cautious — often have HF/COPD)
  • — multifocal automatic foci

Educational reference only. Always follow current ACLS guidelines and institutional protocols.