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POPULAR CARDIOLOGISTS IN SILK BOARD Atrial tachycardia with block Atrial tachycardia with block (paroxysmal atrial tachycardia (PAT) with block) is also an autonomous (automatic, ectopic) atrial tachycardia but its P waves are usually smaller (often discernible only in lead V1) and faster. As a result of this high rate, AV block—mostly 2:1, but often variable—is usually present prior to any exposure to drugs or vagal manoeuvres ). inthe past this was one of the classic manifestations of digoxin toxicity. It can be difficult to distinguish from other atrial rhythms such as AF, flutter and even sinus rhythm ..