What is atrial fibrillation with RVR?
A-fib is the most common rhythm disorder of the heart. In the United States, it affects more than 2.7 million people, according to the American Heart Association.
In a healthy heart, the heart's chambers beat regularly and rhythmically. A-fib is caused by faulty electrical signals in the upper chambers of the heart. In people with A-fib, the heart beats irregularly and often too quickly, getting out of sync with the two lower chambers.
A-fib episodes can come and go or become persistent and require medical treatment.
In a case of A-fib with RVR, the faulty electrical signals are not confined to the upper chambers of the heart. Instead, the lower chambers also respond to the same faulty signals and beat too fast and chaotically. The result is a heart that beats too fast.
A-fib with RVR may have no symptoms and only be discovered during a physical examination or a heart rhythm test. However, most people with the condition will experience some or all of the following symptoms:
Chest pain and heart palpitations are commonly experienced symptoms of A-fib with RVR.
- palpitations (when the heart feels as if it is racing, pounding, or fluttering)
- chest pain
- reduced ability to exercise
- shortness of breath
The symptoms may come and go or persist. In A-fib with RVR, the condition may be:
- Paroxysmal: With paroxysmal A-fib, the symptoms or episodes last anywhere from a few minutes to several hours. The symptoms may go away on their own with no intervention.
- Persistent: In this type of A-fib, the heart doesn't go back to normal on its own and may require medical intervention to restore the normal rhythm.
- Long-standing persistent: This type of A-fib lasts for more than 1 year.
- Permanent: In this kind of A-fib, the heart rate can't be returned to normal. The patient will always have A-fib and may require medications, surgery, or a pacemaker to control the heart rate.
A-fib with RVR needs to be medically managed in order to reduce the risk of serious complications.
While the condition is generally not fatal, it can increase the likelihood of a person developing many serious complications, including:
A doctor may perform several tests in order to diagnose A-fib with RVR. These tests include the following:
- Electrocardiogram (ECG): Small electrodes are attached to a person's chest and arms to record the electrical signals passing through the heart.
- Holter monitor: A Holter monitor is a portable ECG device worn for a longer time to record the heart continuously.
- Event recorder: An event recorder is a Holter monitor worn for up to 1 month. Individuals activate the recorder when experiencing cardiac symptoms.
- Chest X-ray: A doctor may use a chest X-ray to rule out other conditions of the lungs and heart that may cause similar symptoms.
- Stress test: A stress test monitors the heart during exercise.
- Echocardiogram: Sound waves create pictures of the heart that allow doctors to see blood clots that may have formed as a result of A-fib.
- Blood tests: A doctor may order blood tests to rule out thyroid disorders and other problems that can cause similar symptoms.
If medical management and cardioversion are unsuccessful, the doctor may surgically insert a pacemaker.
There are many available treatments to manage A-fib with RVR. The treatment will vary depending on how long a person has had the condition and how bothersome the symptoms are.
Possible treatments include medications, procedures to reset the heart's rhythm, surgery, and preventive measures. The goal of medication and surgery is to reset and control the electrical impulses that cause the fast rhythm. Preventive measures are normally taken to reduce the risk of blood clots.
Medicinal management includes:
- anti-arrhythmic drugs to control the heart's rhythm and prevent future episodes of A-fib
- beta-blockers or calcium channel blockers, medicines that help control the heart rate
- blood thinners to prevent and reduce the risk of blood clots
Medical procedures that may reset the heart's rhythm include two forms of cardioversion.
The first kind of cardioversion takes place when a patient is sedated. A brief electrical shock is delivered to momentarily stop the heart and shock it into resetting to a normal rhythm.
The second type of cardioversion is done with medications under hospital supervision. High doses of anti-arrhythmic drugs are taken by mouth or delivered into a vein, accompanied by constant heart monitoring. The drugs are designed to regulate the heart's rhythm.
Surgical treatment for A-fib with RVR can be considered if medical management or cardioversion procedures don't work.
Surgery options include the following procedures:
During this procedure, the doctor inserts a long tube through a person's groin to access the blood vessels in the heart. When the catheter reaches the heart, the tip will either freeze or heat areas of the heart that are misfiring to kill the tissue and restore the heart's regular rhythm.
If the surgery is successful, it cures the arrhythmia without need for further medication.
Atrioventricular (AV) node ablation
As with a catheter ablation, a catheter is inserted into an artery in the groin and threaded through the artery to the heart. When the catheter reaches the upper chambers of the heart, radiofrequency energy destroys the small area of tissue that connects the upper chambers of the heart to the lower chambers of the heart.
A pacemaker will be implanted and the patient will continue to take blood thinners.
Surgical maze procedure
Unlike either ablation option, the surgical maze procedure is open heart surgery. This creates scar tissue in certain areas of the heart to stop electrical impulses from misfiring.
While this procedure has a high success rate, A-fib may recur. The surgical maze procedure should only be considered when the patient is not suitable for less invasive management.
Management and outlook
While A-fib with RVR is treatable, experts generally don't like to say it is curable. However, with medications and treatment options, symptoms can be greatly reduced and the risk of stroke or heart failure can be lowered significantly.
It's important for anyone with A-fib to follow the advice of their doctor and take all medications as directed.
A low-cholesterol diet and maintaining a healthy weight can help manage the symptoms of A-fib with RVR.
Additionally, a doctor may recommend that people make the following lifestyle changes to help manage their A-fib with RVR:
- lose weight and maintain a healthy weight
- manage high blood pressure
- keep cholesterol levels under control
- eat a heart-healthy diet
- quit smoking
- exercise regularly
- drink alcohol and caffeine in moderation
With proper medical and lifestyle management, a person with A-fib can lead a normal, healthy life with reduced risk of stroke and heart failure. However, it's always important for people with A-fib to maintain regular check-ups and follow up care.