A-fib with RVR refers to atrial fibrillation with a rapid heart rate, or rapid ventricular response. RVR is a complication of A-fib that disrupts blood supply to the body and can involve chest pain, palpitations, and other symptoms.
People with atrial fibrillation (A-fib) with rapid ventricular response (RVR) or other irregular heart rhythms should seek medical attention. Some people may need to spend time in the hospital.
Atrial fibrillation can come and go or become persistent. There is often an association between A-fib and rapid heart rates. Medication can
In this article, find out what A-fib with RVR involves, how to recognize it, and what to do if it happens.
A-fib is the most common rhythm disorder of the heart. In the United States, it affects over
In a healthy heart, the heart’s chambers beat regularly and rhythmically.
A-fib results from faulty electrical signals in the upper chambers of the heart. In people with A-fib, the upper chambers beat quickly and erratically, out of sync with the lower chambers. In A-fib with RVR, the lower chambers beat too quickly and irregularly, resulting in a rapid heart rate.
A doctor may diagnose an RVR from a rapid and irregular ventricular rate when a person’s heart rate is greater than
Sometimes, RVR happens for
- a severe illness, such as
- the use of certain medications, such as epinephrine, norepinephrine, and dopamine
An A-fib with RVR may produce no symptoms. It may only emerge during a physical examination or a heart rhythm test.
A person with A-fib
- palpitations, when the heart feels as if it is racing, pounding, or fluttering
- chest pain
- a reduced ability to exercise
- shortness of breath
A-fib may come and go or persist, with or without RVR.
A doctor may describe it as:
- Paroxysmal: Paroxysmal A-fib lasts up to
- Persistent: Persistent A-fib lasts more than 7 days
- Long-standing persistent: Lasting longer than 1 year, despite treatment.
- Permanent: The A-fib persists despite attempts to restore the usual heart rhythm.
A-fib with RVR can lead to serious complications,
A doctor may perform several tests to diagnose A-fib with RVR, including:
- Electrocardiogram (ECG): In an ECG, small electrodes attached to the chest and arms record the electrical signals passing through the heart.
- Rhythm monitor: A monitor, such as a Holter monitor, is a wearable ECG device that records the heart continuously.
- Event recorder: This is a type of Holter monitor worn for up to 1 month. When cardiac symptoms occur, they activate the monitor.
- Chest X-ray: An X-ray can help evaluate other heart or lung conditions that may cause similar symptoms.
- Echocardiogram: In an echocardiogram, also known as an echo, sound waves create pictures of the heart that allow doctors to see blood clots that may result from A-fib.
- Blood tests: Blood tests can rule out conditions with similar symptoms, such as thyroid disorders.
Possible treatments for A-fib with RVR include:
- procedures to reset the heart’s rhythm
- invasive procedures, such as catheter ablation
- preventive measures
Treatment approaches can include a rate control approach or a rhythm control approach.
A rate control approach aims to manage the heart rate, although the person may either stay in A-fib or go in and out of A-fib.
In rhythm control, doctors use medications or procedures to try to keep the heart in a normal rhythm.
Options for medicinal management for A-fib with RVR include:
- antiarrhythmic drugs,
such asamiodarone, that control the heart’s rhythm and prevent future episodes of A-fib
- beta-blockers, such as metoprolol (Lopressor) to manage the heart rate
- calcium channel blockers, such as diltiazem (Cardizem), which can help control the heart rate
- blood-thinning drugs to reduce the risk of blood clots
In the hospital, a doctor may use a technique known as cardioversion.
In electrical cardioversion, a doctor will deliver a brief electrical shock to momentarily stop the heart, which shocks it into resetting to a normal rhythm.
In chemical or pharmacological cardioversion, a person takes antiarrhythmic drugs by mouth or intravenously. This usually happens in a hospital, although a doctor may prescribe pills for a person to use when they notice signs of A-fib. The drugs regulate the heart’s rhythm.
A doctor may recommend invasive procedures for A-fib with RVR if other options are not effective.
Pulmonary vein ablation
Catheter ablation is when a doctor inserts a long tube through the groin to access the blood vessels in the heart.
In pulmonary vein ablation, 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 the need for further medication to manage the heart’s rate or rhythm.
Atrioventricular (AV) node ablation
As with pulmonary vein ablation, a doctor inserts a catheter into an artery in the groin and threads it 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 and lower chambers.
The doctor will implant a pacemaker and the person will continue using blood thinners.
The person will need a pacemaker because the procedure has cut off communication between the upper and lower chambers. This can lead to a slow rhythm, known as bradycardia. The pacemaker will help the heart continue beating at a steady rate.
Surgical maze procedure
The maze procedure involves open heart surgery. It creates scar tissue in specific areas of the heart to stop electrical impulses from misfiring.
This procedure has a high success rate, but A-fib may recur. The surgical maze procedure is usually only for people having cardiac surgery for other reasons, such as a valve replacement.
A-fib with RVR is treatable, but doctors consider A-fib a chronic, or long-term, disease. People may need to continue with medications and other treatments to manage their symptoms and reduce their risk of stroke or heart failure.
A doctor may also recommend some lifestyle tips,
- maintaining a moderate weight
- managing blood pressure and cholesterol levels
- following a heart-healthy diet
- avoiding or quitting smoking
- exercising regularly
- consuming alcohol in moderation
These tips can also help prevent heart problems from developing.
Anyone with A-fib should follow a doctor’s advice and take all medications as directed.
Atrial fibrillation with rapid ventricular response is a type of irregular heart rhythm. A-fib can lead to RVR, and RVR can increase the risk of complications, such as blood clots or stroke.
Treatment for both will be the same and includes medications, invasive procedures, and lifestyle choices. Treatment will aim to manage the heart rhythm and prevent further problems.
There may be no symptoms of A-fib or A-fib with RVR, but attending regular checkups can help a doctor diagnose problems early when they are often easier to treat.