SHM's Clinical Quick Talks-Atrial Fibrillation with Rapid Ventricular Rate

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Atrial fibrillation with rapid ventricular rate (RVR) is a condition where the atrial chambers of the heart fibrillate and the ventricular rate is faster than normal. It can be caused by ectopic foci, single circuit re-entry, or multiple circuit re-entry. The ventricular rate can be up to 400 beats per minute but is usually around 100 bpm. EKG findings include a narrow QRS complex, irregularly irregular ventricular rate, and no discernable P waves. The condition can be caused by cardiac issues such as structural or valvular heart disease, acute decompensated heart failure, or ischemia, as well as non-cardiac issues like pulmonary disease, thyrotoxicosis, drug intoxication, or metabolic derangements. <br /><br />Management of atrial fibrillation with RVR depends on the stability of the patient. If the patient is unstable, synchronized cardioversion is recommended. If the patient is stable, treatment options depend on the heart rate. If the heart rate is above 130 bpm, IV medications like metoprolol, esmolol, diltiazem, digoxin, or amiodarone can be used. If the heart rate is below 130 bpm or the patient is in normal sinus rhythm after IV treatment, oral medications like metoprolol, diltiazem, amiodarone, or digoxin can be prescribed.<br /><br />Some clinical pearls to consider when dealing with atrial fibrillation with RVR are to assess the stability of the patient and cardiovert if they are unstable. Beta-blockers and calcium channel blockers are the first-line treatment options for this condition.

Asset Subtitle

Praneeja Matta, Kathryn Haroldson

Keywords

Atrial fibrillation with RVR

ventricular rate

EKG findings

cardiac issues

non-cardiac issues

management

stability of the patient

heart rate

IV medications

oral medications

Praneeja Matta

Study Guide