Is AFib With RVR Life-Threatening?

Atrial fibrillation may not always cause symptoms. 

Mild symptoms of atrial fibrillation may include:

• Irregular heartbeat (arrhythmia)
• Heart palpitations 
• Racing heartbeat
• Chest tightness, pain, or discomfort
• Dizziness
• Lightheadedness
• Mild shortness of breath
• Weakness/lack of energy
• Exercise intolerance 

Severe symptoms of atrial fibrillation may include:

• Chest pain (angina)
• Difficulty breathing, both with and without exertion
• Fainting
• Severe fatigue

AFib with RVR (atrial fibrillation with a rapid ventricular rate) is caused by faulty electrical signals in the heart.

Risk factors for developing AFib with RVR include age and underlying heart diseases. The most common causes of AFib include heart conditions such as:

• Heart disease due to chronic high blood pressure (hypertensive heart disease)
• Heart failure 
• Heart valve disease, such as mitral regurgitation or mitral stenosis 
• Heart attack
• Coronary artery disease
• Complications from heart surgery or complications resulting from other types of surgery
• Congenital heart defects

Other risk factors for developing AFib with RVR include:

• Alcohol binge drinking 
• Obesity
• Overactive thyroid gland (hyperthyroidism)
• Sleep apnea 
• Certain medications, including drugs that stimulate the heart such as theophylline
• Use of stimulants such as caffeine or nicotine
• Chronic lung diseases such as emphysema
• Chronic kidney disease (CKD)
• Diabetes 
• Asthma
• Viral infections
• Advanced age
• Family history of AFib
• Supraventricular tachycardia (SVT)

AFib with RVR (atrial fibrillation with a rapid ventricular rate) is diagnosed with an electrocardiogram (ECG or EKG), a test that measures the heart's electrical activity. 

A Holter or event recorder (devices worn over 1-2 days that monitor heart activity using an ECG recording) may be used in some cases. 

Tests that may be indicated to check for other problems include:

• Echocardiogram (ultrasound) to check for heart failure or heart valve problems
• Sleep studies to check for sleep apnea
• Lung function tests to look for underlying lung disease
• Blood tests to screen for thyroid disorders

The goal of treatment for AFib with RVR (atrial fibrillation with a rapid ventricular rate) is to control heart rhythm and rate and to stop blood clots from forming (anticoagulation) to prevent stroke. 

Treatment to control heart rhythm includes:

• Electrical cardioversion (usually the first-line treatment in young patients who have symptoms)
• Antiarrhythmic medications 
  • Flecainide (Tambocor)
  • Propafenone (Rythmol)
  • Dofetilide (Tikosyn)
  • Amiodarone (Cordarone, Nexterone)
  • Sotalol (Betapace)
• Ablation (catheter-based, surgical, or hybrid) using heat (radiofrequency ablation) or cold (cryoablation)
• Surgical procedures, including the “maze procedure”

Treatment to control heart rate includes:

• Medications
  • Non-dihydropyridine calcium channel blockers (Cardizem)
  • Beta-blockers
  • Digoxin (Lanoxin)
  • Amiodarone (Cordarone, Nexterone)
• Placement of a permanent pacemaker (used when other rate and rhythm control alternatives have not been successful)

Anticoagulation treatments include:

• Aspirin 
• Intravenous (IV) heparin or low-molecular-weight heparin (LMWH) 
• Warfarin (Coumadin)
• Newer oral anticoagulants
  • Direct thrombin inhibitor: Dabigatran (Pradaxa)
  • Factor Xa inhibitors
    • Rivaroxaban (Xarelto)
    • Apixaban (Eliquis)
    • Edoxaban (Savaysa)