What Is AFib With Rapid Ventricular Response?

Treatment of AFib With RVR Cont.

Cardioversion for AFib With RVR

When AFib with RVR fails to respond to medication, and you are experiencing adverse signs and symptoms, shocking the heart out of the irregular rhythm becomes necessary.

If you have no symptoms, cardioversion is an option for your physician to consider if the AFib with RVR has lasted more than 48 hours and you aren’t taking any anticoagulant medications.

The procedure, called cardioversion, involves sedating the individual with a mild anesthetic and placing the paddles of a defibrillator on the chest to deliver a shock.

The defibrillator uses electrical current to jolt the heart out of AFib and back to a normal rhythm.

The rate of electrical current, called joules, is set at 120-200J, with more than one shock available if needed. Soreness in the chest is sometimes a side effect after cardioversion.

If the abnormal rhythm responds to cardioversion but returns, the next recommendation is an ablation procedure.

Cardiac Ablation for Management of AFib With RVR

Cardiac ablation is a minimally invasive technique used to create tiny burns around the heart or the pulmonary vein that block the altered electrical pathway causing the rhythm and rate issue. Ablation takes place in the hospital, often under general anesthesia.

Ablation is not an emergency intervention and occurs at a time when the individual’s condition is stable. For many people, ablation can prevent recurrence of AFib with RVR.

The physician passes a small flexible wire through a vein in the neck or groin and threads it up to the heart. Once the wire is in position, the physician sends an electrical impulse through it that creates heat and burns the heart tissue responsible for creating the AFib.


Cold is an option to use in place of heat, which will freeze the area causing the AFib. Hospitalization for ablation usually is one or two days.

You will need to take an antiarrhythmic medication for a few months after ablation to ensure the heart maintains a normal rhythm. Symptoms are typical for a brief amount of time while the heart is recovering from the surgery.

After your ablation, you will receive instructions on activity restrictions to allow your heart and incision site time to heal. Soreness in your incision site is normal and will resolve with time.

Pacemaker Implantation for Management of AFib With RVR

For people who remain in AFib with RVR without resolution after attempting drugs and cardioversion, a pacemaker is often the final choice.

The pacemaker is roughly the size of a silver dollar. A cardiologist performs a minor procedure and places the appliance beneath the skin in the left upper chest area.

The pacemaker has wires called leads that attach to different areas of the heart. The leads use electrical current to help regulate heart rate and rhythm to keep it under control.

Pacemaker implantation often requires a hospital stay of roughly 24 hours with the individual released home the day after the procedure.

People receive instructions not to raise their arm over their head on the side of their procedure for a few weeks to allow the wires and the surgical incision to heal.

My Experience of AFib With RVR

My experience of AFib with RVR occurred on the evening of December 30, 2011. My heart rate suddenly accelerated while I was eating a bowl of ice cream topped with frozen blueberries.

My pulse rate was too fast to count, and I experienced tightness in my chest and up into my neck, shortness of breath, weakness, fatigue, and dizziness. I also felt a fluttering sensation like a butterfly was inside my heart trying to escape.

I arrived at the emergency room and had a nurse hook me up to an EKG monitor. The screen showed my heart rate was between 180 and 190 beats per minute.

The ER physician ordered an IV beta-blocker and when this didn’t work followed with a calcium channel blocker, which yielded the same result.

The cardiologist on call assessed the problem and then transferred me to the ICU, placing me on a slow flowing IV of antiarrhythmic medication. After seven hours, my heart converted to a normal rhythm, and the cardiologist discharged me home.

Unfortunately, my AFib with RVR was not an isolated event. Over the next three and half years, I experienced six more episodes.

My primary trigger was either heat or cold. In one instance, I was taking a hot shower in the morning and suddenly felt my heart jump into AFib.

The other heat-related episode occurred while sitting in a hot tub in a foreign country. I wasn’t fluent in the language and was not going to test the healthcare system, so I decided to “ride out” the eight-hour episode.

I also noticed that stress was a trigger, mainly when I was under a good deal of pressure at work.

One pattern I saw with my AFib with RVR was that occurrences lasted an average of eight hours. Some episodes resolved with medication, while others required cardioversion.

A single event ceased on its own after medication and cardioversion had failed.

At this point, my cardiologist stated that I should consider cardiac ablation. He said I was a good candidate for the procedure because of my past medical history and because I had no other heart-related problems.

I had complete trust in my cardiologist. I had an existing professional relationship with him as he was also the medical director for the cardiac rehab department that I managed.

He referred me to an electrophysiologist at a large heart center out-of-state. My ablation and was successful and I had to take an antiarrhythmic drug for three months after discharge.

However, I did have a brief incident of atrial flutter after returning home because of dehydration. The situation did require hospitalization for 24 hours, and I received fluids and a slow flowing IV of amiodarone, which corrected the problem.

To date, I have had no further flare-ups of AFib with RVR.

AFib with RVR is a significant problem because if left untreated, it can lead to stroke, congestive heart failure, and cardiogenic shock. If you experience a rapid heart rate with any of the symptoms discussed earlier, don’t delay in seeking medical care.

There are a variety of treatment options available for managing AFib with RVR, with advances happening on a frequent basis. Ask your doctor about new protocols that might be the right choices for your situation.

With the right care, your AFib with RVR is manageable and will allow you to have an enjoyable and productive life.


American Heart Association (Treatment Guidelines for Atrial Fibrillation)

American Journal of Critical Care (Rapid Ventricular Response)

Cleveland Clinic Center for Continuing Education (Cleveland Clinic Atrial Fibrillation)

Healthline (What are the Dangers of Afib with RVR?)

theheart.org (Atrial Fibrillation: Practice Essentials, Background, Pathophysiology)

WebMD (Afib with Rapid Ventricular Response)

WebMD (Catheter Ablation for Atrial Fibrillation)

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Avoiding Complications of Atrial Fibrillation

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by Patricia Bratianu on February 3, 2015
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