Date:
Patient:
MRN:
Clinician: (Cardiologist, Electrophysiologist)
Reason for Visit:
Evaluation and management of focal atrial tachycardia (FAT)
(Optional) Specific reason for evaluation (symptomatic vs. incidental finding)
History of Present Illness:
Age at presentation
Presence and description of symptoms associated with FAT episodes (palpitations, shortness of breath, chest pain, dizziness, presyncope, syncope)
Frequency and duration of FAT episodes
Response to previous interventions (medications, ablation)
Past Medical History:
Underlying structural heart disease (congenital heart defects, valvular heart disease, cardiomyopathy)
History of hypertension, sleep apnea, or other medical conditions that may contribute to FAT
Previous surgeries (cardiac or non-cardiac)
Family History:
Family history of heart rhythm problems
Medications:
Current medications, including any medications for rate control or rhythm control used for FAT
Social History:
Smoking history (risk factor for atrial fibrillation)
Caffeine and alcohol use (potential triggers for FAT)
Physical Exam:
Vital Signs: Heart rate (regular vs. irregular during FAT episode), blood pressure
Cardiovascular: Murmurs (if present) suggestive of underlying structural heart disease
ECG (Electrocardiogram):
Describe the ECG findings, including:
Presence of FAT on ECG (narrow QRS complex tachycardia with characteristic P wave morphology)
Underlying heart rhythm (sinus rhythm, atrial fibrillation)
Pre-excitation (delta wave) suggestive of Wolff-Parkinson-White (WPW) syndrome (a specific type of FAT)
Holter Monitor or Event Recorder (if used):
Summarize the findings of any ambulatory rhythm monitoring devices used to capture FAT episodes.
Echocardiogram:
Briefly describe the results of the echocardiogram to assess for structural heart disease or other abnormalities.
Assessment:
Confirm the diagnosis of FAT based on clinical presentation, ECG findings, and additional investigations.
Identify the potential trigger(s) for FAT episodes.
Assess the hemodynamic impact of FAT (symptomatic vs. asymptomatic).
Plan:
Outline the treatment plan based on the severity of symptoms, hemodynamic impact, and patient preference:
Rate control medications: Medications to slow down the heart rate during FAT episodes (beta-blockers, calcium channel blockers)
Rhythm control medications: Medications to suppress or terminate FAT episodes (antiarrhythmics)
Catheter ablation: Minimally invasive procedure to target and eliminate the tissue causing FAT.
Watch and wait: For asymptomatic patients with infrequent and well-tolerated episodes.
Prognosis:
Briefly discuss the prognosis. With appropriate management, most patients with FAT can achieve good control of symptoms and improve their quality of life.
Education:
Document any education provided to the patient regarding:
The nature of FAT and its potential causes
The importance of identifying and avoiding triggers
The risks and benefits of various treatment options
Warning signs and symptoms to watch for
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the diagnosis and treatment plan, and any concerns they may have.
Consider mentioning the importance of follow-up for monitoring and potential adjustments to the treatment plan.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a cardiologist or electrophysiologist for diagnosis and treatment recommendations.