Atrial Fibrillation with Rapid Ventricular Response (AFib with RVR)

Introduction

Atrial fibrillation (AFib) is an irregular and often rapid heart rhythm originating from the atria, the upper chambers of the heart. When AFib leads to a very fast heart rate, typically greater than 100 beats per minute, it is called Atrial Fibrillation with Rapid Ventricular Response (AFib with RVR). This condition requires urgent medical attention to prevent complications such as heart failure and stroke.

Causes and Triggers

Several factors can lead to AFib with RVR, including: - Underlying heart disease (e.g., hypertension, coronary artery disease, heart failure) - Hyperthyroidism (overactive thyroid) - Excessive alcohol or caffeine consumption - Electrolyte imbalances - Severe infections or sepsis - Lung diseases (e.g., chronic obstructive pulmonary disease - COPD)

Symptoms

• Palpitations or rapid heartbeat
• Shortness of breath
• Dizziness or lightheadedness
• Fatigue
• Chest discomfort
• Anxiety

Diagnosis

To diagnose AFib with RVR, doctors typically use: - Electrocardiogram (ECG) to confirm irregular rhythm and rapid rate. - Blood tests to check for thyroid function, electrolytes, and infections. - Echocardiogram to evaluate heart structure. - Continuous monitoring (Holter monitor or event monitor) if intermittent symptoms occur.

Treatment Approaches

Treatment aims to control heart rate, restore normal rhythm, and prevent blood clots.

1. Rate Control

Slowing the heart rate is the first step: - Beta-blockers (e.g., metoprolol) - Calcium channel blockers (e.g., diltiazem, verapamil) - Digoxin (less commonly used, mainly for heart failure patients)

2. Rhythm Control

If necessary, restoring normal rhythm is achieved using: - Electrical Cardioversion (a controlled shock to the heart) - Antiarrhythmic Medications (e.g., amiodarone, flecainide)

3. Anticoagulation (Blood Thinners)

To reduce the risk of stroke, many patients with AFib require anticoagulants: - Warfarin (requires INR monitoring) - Direct Oral Anticoagulants (DOACs) (e.g., apixaban, rivaroxaban)

Prevention

• Manage high blood pressure and heart disease
• Limit alcohol and caffeine intake
• Maintain a healthy diet and exercise regularly
• Monitor thyroid function and electrolyte balance

Conclusion

AFib with RVR is a serious but manageable condition. Early intervention can prevent severe complications such as heart failure and stroke. If you experience symptoms, seek medical attention immediately.

Source recommendations

1. 2023 European Society of Cardiology (ESC) Guidelines for the Diagnosis and Management of Atrial Fibrillation

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Atrial-Fibrillation
2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
3. https://pubmed.ncbi.nlm.nih.gov/32860505/
4. https://www.jacc.org/doi/10.1016/j.jacc.2023.10.021
5. https://academic.oup.com/eurheartj/pages/esc_guidelines

2. 2020 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Rhythm Society (HRS) Guideline for the Management of Patients With Atrial Fibrillation

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193
2. https://pubmed.ncbi.nlm.nih.gov/38033089/
3. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000665
4. https://pubmed.ncbi.nlm.nih.gov/30703431/
5. https://www.acc.org/Latest-in-Cardiology/ten-points-to-remember/2020/12/04/20/16/2020-Update-to-ACC-AHA-AF-AFL-Performance