AFib with RVR: The Essential Guide on Symptoms and Treatment | Dr. AFib (2023)

Did you know that there are many different types of atrial fibrillation (AFib)?

While many symptoms of atrial fibrillation are similar, specific types can cause additional risks and require additional monitoring and management. Correct identification of your atrial fibrillation is essential for getting the proper treatment and care you need.

As an electrophysiologist, I work with AFib patients everyday to properly diagnose their specific subtype of atrial fibrillation, and create a personalized treatment plan.

Here is everything you need to know about AFib with RVR:

What is AFib with RVR?

AFib with RVR is a subtype of the overall condition of atrial fibrillation. RVR stands for rapid ventricular rate, which is defined as a heart rate of over 100 beats per minute.

To better understand this condition, we first need to understand the basic anatomy of the human heart. The heart has four chambers — two upper atriums and two lower ventricles. In patients with atrial fibrillation, the atrium is beating so fast that it is basically quivering. The atrium rate can get up to 600 beats per minute.

What is the Difference Between AFib and AFib with RVR?

Fortunately, in AFib the overall pulse does not go as fast as the atria do, but they can still become very rapid with heart rates from 100 -200 beats per minute. That is what happens during AFib with RVR, the overall pulse rate is very rapid, over 100 beats per minute. On the other hand, AFib with controlled ventricular rate is defined as AFib where the overall pulse is not rapid, usually betweem 60-100 beats per minute.

What are the Causes of AFib with RVR?

There are several known common risk factors for atrial fibrillation. The common risk factors for atrial fibrillation are the same as risk factors for AFib with RVR. Some of the most common risk factors for atrial fibrillation include:

● Having uncontrolled high blood pressure

● Having an elevated body mass index (BMI)

● A history of heart disease (having a past history of a heart attack or congestive heart failure, for example)

● Family history of atrial fibrillation

● Advanced age (the incidence of new atrial fibrillation significantly increases after 60 years of age)

● Living with other chronic health conditions, such as sleep apnea, diabetes, lung disease, or thyroid conditions

● Alcohol abuse

(Video) AFib with RVR: Symptoms and Treatment

Symptoms for AFib with RVR

Because AFib with RVR is a type of atrial fibrillation, the symptoms are very similar. That being said, one big difference is the resting heart rate between these two conditions. People with AFib with RVR experience an elevated heart rate, leading to the feeling of your heart pounding in your chest and increased anxiety.

Common symptoms of AFib with RVR include:

● Heart palpitations, fluttering, or the feeling of it pounding in your chest

● Fatigue

● Chest tightness and pain

● Shortness of breath

● Confusion

● Dizziness and lightheadedness

● Overall weakness

Complications of AFib with RVR

Just like any type of atrial fibrillation, patients with AFib with RVR are at risk of developing serious complications.

Some of the most common complications include:

Blood clots — When blood cannot properly circulate from the heart’s atriums, blood clots can form. These clots can result in serious medical emergencies, such as pulmonary embolisms, heart attacks, and strokes.

Heart failure — Heart failure occurs when the heart muscle has been damaged. Uncontrolled atrial fibrillation can wear down the heart muscle, resulting in overall poor heart function and heart failure. This is an elevated risk for people with AFib with RVR, as the entire heart is working harder to beat at the elevated rate.

Stroke — People with AFib are at a significantly elevated risk of developing a stroke. A stroke is a serious medical condition caused by a blood clot becoming lodged in the vessels of the brain. Use the helpful acronym F.A.S.T to identify the common symptoms of a stroke:

(Video) Atrial fibrillation (A-fib, AF) - causes, symptoms, treatment & pathology

Face Drooping: Is one side of their face drooping?

Arm Weakness: Are they experiencing one-sided weakness of an arm or leg?

Speech Difficulty: Is their speech slurred or difficult to understand?

Time to Call 911: If someone shows any of these symptoms, even if the symptoms go away, call 911 and get them to the hospital immediately.

Treatment for AFib with RVR

There are many different treatment options for AFib with RVR. The treatment option best suited for you will be dependent on your symptoms, health history, and lifestyle.

The most common treatment for AFib with RVR is the use of rate-controlling medications. These can be taken orally at home or used during an emergency situation in the hospital. In an emergency room, a patient will likely receive intravenous medications for rapid control of the heart rate. Some of the most commonly used medications include:

● Metoprolol

● Diltiazem


● Amiodarone

When medical therapy cannot resolve an episode of AFib with RVR, the next option may be a procedure. The most common first procedure performed in a hospital setting is a cardioversion. A cardioversion is an electrical shock used to return the heart to a normal rhythm. Read more about cardioversion procedures here.

Finally, in patients with long-term unresolved AFib with RVR, an invasive procedure may be required. A catheter ablation procedure is a common treatment option to reduce episodes of AFib with RVR. Read more about ablation procedures here.

Frequently Asked Questions About AFib with RVR:

Is AFib with RVR Life-Threatening?

The most dangerous part about AFib with RVR is not necessarily the heart rate — it is actually the symptoms that patients may feel. I've had patients who have had elevated heart rates of 120 or 130 bpm for weeks at a time — and the crazy thing is, they are fairly asymptomatic. However, many people feel their episodes of atrial fibrillation very differently.

Some patients experience severe symptoms during episodes of atrial fibrillation. Symptoms like shortness of breath, feeling dizzy or light-headed, or having chest pain are examples of AFib symptoms that require medical attention. However, the most significant danger of any type of atrial fibrillation is an increased risk for stroke. Learn more about the risk of stroke for AFib patients here.

(Video) AFib with RVR Made Easy (Atrial Fibrillation with Rapid Ventricular Response)

Can Stress Cause AFib with RVR?

Stress can trigger episodes of AFib, including AFib with RVR. Some common sources of stress include:

● Poor work-life balance

● Lack of sleep

● Increased alcohol use

● Eating unhealthy foods

● Having elevated levels of stress hormones

What is the Heart Rate for AFib with RVR?

To be diagnosed with AFib with RVR, a patient needs to have a resting heart rate of over 100 beats per minute. That being said, I have frequently seen heart rates of close to 200 beats per minute in patients with AFib with RVR.

When the heart rate of AFib is between 60-100 beats per minute, it is defined as controlled ventricular rate or CVR.

What are Some Triggers of AFib with RVR?

While every case of AFib is different, some common triggers increase your likelihood of experiencing an episode of AFib. Common triggers include:

● Sleep deprivation

● Increased alcohol consumption

● Illness

● Increased stress

● Hormonal changes

● Strenuous exercise

● Caffeine

(Video) Atrial Fibrillation with Rapid Ventricular Response (Afib RVR) - EMERGENCY NURSING

How Can You Stop AFib with RVR at Home?

There are a few at home methods that can may be able to stop an episode of AFib with RVR, and ultimately avoid a visit to an emergency room. Some methods include:

● Vagal Manuevers

● Meditation

● Yoga

● Exercise

● Taking Additional Medications (always discuss with your doctor if taking extra medications is safe for you)

To read more about stopping an AFib episode at home, read my article here.

How To Reverse Atrial Fibrillation Naturally

If you are interested in natural treatment options for atrial fibrillation and are highly motivated in improving your symptoms naturally, to reduce your need for medications or even procedures, then take a look at my one-of-a-kind, online educational program, Take Control Over AFib.

Lifestyle modifications and reducing inflammation are essential components of the long-term management of atrial fibrillation. Addressing the source cause of atrial fibrillation can lead to a significant benefit for most AFib patients. Targeted lifestyle modifications can reduce your symptoms, reduce your reliance on medications or procedures, and even improve the long-term success rate of a catheter ablation procedure for AFib. However, most patients are not given instructions or tips on how to accomplish these essential lifestyle modifications in an AFib targeted style.

This is exactly why I created the Take Control Over AFib Program, to give people a step-by-step plan to improve and potentially reverse atrial fibrillation naturally.

Thinking about lifestyle modifications is easy, but putting in place a system to keep you committed to achieve real results takes time and dedication, and with my step-by-step plan, we can achieve powerful and long-lasting results together.

The Take Control Over AFib Online Program is currently only available in English Language.

Learn More About The Take Control Over AFib Program Here

Putting It All Together

Overall, AFib with RVR is treated very similarly to regular atrial fibrillation. That being said, it is essential to see your doctor if you notice any change to your heart rate, as you may require medical attention.

(Video) AFib Treatment: What Works The Best?

As an electrophysiologist, I work with patients with a wide variety of heart arrhythmias. If you have any questions about atrial fibrillation, I would love to chat with you about it! Follow me on social media and ask me a question— I am looking forward to hearing from you!


What is the initial treatment for AFib with RVR? ›

Treatment for AFib with RVR

The most common first procedure performed in a hospital setting is a cardioversion. A cardioversion is an electrical shock used to return the heart to a normal rhythm.

How serious is AFib with RVR? ›

AFib with RVR is one of the most dangerous forms of Arrhythmias since it can increase an individual's chances of having a: Heart attack. Stroke. Decrease in the overall efficiency of the circulatory system due to inefficient blood flow that can result in irreversible organ damage.

What heart rate is considered AFib with RVR? ›

What Does AFib With RVR Feel Like? A normal heartbeat is 60 to 100 beats per minute (BPM). In AFib with RVR, your heart rate can reach more than 100 BPM.

How do you get out of AFib RVR? ›

6 Ways to Stop an AFib Episode
  1. Engage in deep, mindful breathing. ...
  2. Get some exercise. ...
  3. Valsalva maneuver. ...
  4. Practice yoga. ...
  5. Put some cold water on your face. ...
  6. Contact a health professional.

Does metoprolol treat AFib with RVR? ›

In this study, metoprolol was the most commonly used agent for atrial fibrillation with RVR. Metoprolol had a lower failure rate than amiodarone and was superior to diltiazem in achieving rate control at 4-hours.

How long can you be in AFib with RVR? ›

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.

What does AFib with RVR feel like? ›

If you have AFib with RVR you'll experience symptoms, typically a rapid or fluttering heartbeat. You can also experience chest pain, shortness of breath, dizziness, or passing out. RVR can be detected and confirmed by your doctor. It can cause serious complications and requires treatment.

Can anxiety cause AFib with RVR? ›

Feeling depressed or anxious can make AFib. Feeling angry or stressed about work may make AFib. Having anxiety increases the risk of AFib.

When should I go to the ER for AFib RVR? ›

AFib episodes rarely cause serious problems, but they'll need to get checked out. If they're uncomfortable or their heart is beating rapidly, call 911 or go to an emergency room.

What should you not do if you have atrial fibrillation? ›

If you have A-fib , it's also important to know which foods and drinks to avoid. For example, your care provider may recommend that you limit or avoid alcohol. Alcohol can cause health issues in some people. People with atrial fibrillation often take blood thinners to prevent blood clots.

At what heart rate should you go to the hospital? ›

If you're sitting down and feeling calm, your heart shouldn't beat more than about 100 times per minute. A heartbeat that's faster than this, also called tachycardia, is a reason to come to the emergency department and get checked out. We often see patients whose hearts are beating 160 beats per minute or more.

What triggers RVR? ›

Causes of A-fib with RVR include: Coronary artery disease. High blood pressure. Heart failure.

Can you pull yourself out of AFib? ›

Vagal Maneuvers

Types you can try for Afib include: Close your nose and mouth and try to blow out to create pressure in your chest. This “Valsalva” technique can be very effective.

Why do people go into AFib with RVR? ›

Some cases of Afib involve atrial fibrillation with rapid ventricular response (RVR). This is when the rapid contractions of the atria make the ventricles beat too quickly. If the ventricles beat too fast, they can't receive enough blood. So they can't meet the body's need for oxygenated blood.

Does metoprolol keep you out of AFib? ›

It has been shown recently that the beta-blocker metoprolol controlled release/extended release (CR/XL) is also effective in maintaining sinus rhythm after conversion of atrial fibrillation.

How much metoprolol can I take to stop AFib? ›

Adults—At first, 25 to 100 milligrams (mg) once a day. Your doctor may adjust your dose as needed. However, the dose is usually not more than 400 mg per day.

Which beta-blocker is best for atrial fibrillation? ›

Bisoprolol* or metoprolol succinate are first-choice beta-blockers for patients with atrial fibrillation as they are prescribed once-daily and do not require dose adjustment in patients with renal impairment. Bisoprolol is preferred as it is more cardioselective than metoprolol and may cause more bradycardia.

What happens if you stay in AFib too long? ›

In atrial fibrillation, the chaotic heart rhythm can cause blood to collect in the heart's upper chambers (atria) and form clots. If a blood clot in the left upper chamber (left atrium) breaks free from the heart area, it can travel to the brain and cause a stroke.

What aggravates atrial fibrillation? ›

Certain situations can trigger an episode of atrial fibrillation, including: drinking excessive amounts of alcohol, particularly binge drinking. being overweight (read about how to lose weight) drinking lots of caffeine, such as tea, coffee or energy drinks.

What are the symptoms of AFib getting worse? ›

If you notice that your AFib episodes happen more often, last longer, or your medication doesn't help as much, your condition is probably getting worse. As AFib progresses, you might notice some signs. You might feel more weak, tired, lifeless, and anxious about the condition.

Does AFib make you sleep a lot? ›

Everyone gets tired from time to time, but the fatigue that accompanies a heart condition like Afib is often described as: Constantly tired. Drained. Exhaustion.

What is the best sleeping position for AFib? ›

There is no clear sleep position that is beneficial for atrial fibrillation. However, most AFib patients notice less symptoms while sleeping on their side.

How long should you be in AFib before ER? ›

A conservative, safe approach is to go to the ER if your heart rate is over 100 bpm and/or lasts for 24-48 hours.

How long do you have to be in AFib before clot forms? ›

The traditional concept proposes that atrial thrombus forms only after > 2 days of AF and embolizes by being dislodged from increases in shear forces. This widely accepted concept further holds that newly formed atrial thrombus, in the setting of AF, organizes over a span of 14 days.

Should you rest when you have AFib? ›

If you are in AF all the time (persistent AF), you can exercise as much as you want, as long as your heart rate is under control, you are stable on your treatment and are feeling well. If you're not feeling well because of your AF, ask your GP or specialist for exercise advice.

Should you rest during AFib? ›

Remember that no matter what activity you're doing, if you experience any symptoms related to atrial fibrillation — like lightheadedness or chest pain or pressure — you should stop and rest for a while, says Hussein.

What is an alarming heart rate? ›

You may want to start with a visit to your health care provider if your heart rate is consistently above 100 beats per minute or below 60 beats per minute (and you're not an athlete), or if you're also experiencing shortness of breath, fainting spells, lightheadedness or feeling fluttering or palpitations in your chest ...

What heart rate is extreme? ›

Tachycardia (tak-ih-KAHR-dee-uh) is the medical term for a heart rate over 100 beats a minute.

Will drinking water lower heart rate? ›

Staying hydrated

A 2017 study found that a 335-milliliter drink of water could reduce resting heart rate over a 30-minute period. This decline continued for another 30 minutes. Drinking plenty of beverages throughout the day could lower a person's heart rate.

What is the immediate treatment for AFib? ›

Immediate electrical cardioversion is recommended in patients with acute atrial fibrillation and a rapid ventricular response associated with acute myocardial infarction, symptomatic hypertension, angina, or heart failure that does not respond promptly to pharmacological measures.

Do you give amiodarone for AFib RVR? ›

The administration of 7 mg/kg of intravenous amiodarone delivered in 30 min proved a safe and successful first choice of management in atrial fibrillation with a rapid ventricular response.

How do paramedics treat AFib with RVR? ›

The protocol for treatment of “Atrial Fibrillation/Flutter” directed paramedics to administer a dose of diltiazem 0.25mg/kg (maximum dose of 20mg) to adult patients with stable, symptomatic AFIB or atrial flutter with RVR at a rate greater than 150 beats per minute (bpm) with a narrow complex rhythm (Figure 1).

What is the most appropriate treatment for a patient with atrial fibrillation? ›

Cardioversion. Cardioversion may be recommended for some people with atrial fibrillation. It involves giving the heart a controlled electric shock to try to restore a normal rhythm. Cardioversion is usually carried out in hospital so the heart can be carefully monitored.

What should you not do with AFib? ›

Here are a few other diet tips for people who have AFib:
  • Go to a healthier-fat, low-salt diet. Avoid saturated fat, trans fat, and salt to help control your blood pressure and cholesterol levels. ...
  • Limit caffeine. ...
  • Cut back on alcohol. ...
  • Regular amounts of vitamin K.
Mar 7, 2021

What can worsen atrial fibrillation? ›

drinking excessive amounts of alcohol, particularly binge drinking. being overweight (read about how to lose weight) drinking lots of caffeine, such as tea, coffee or energy drinks. taking illegal drugs, particularly amphetamines or cocaine.

What heart rate is too high with AFib? ›

The most obvious symptom of atrial fibrillation (AF) is palpitations caused by a fast and irregular heartbeat. A normal heart rate, when you are resting, should be between 60 and 100 beats a minute. In atrial fibrillation, it may be over 140 beats a minute.

When should you not give amiodarone? ›

Amiodarone therapy is contraindicated in patients with second- or third-degree heart block who do not have a pacemaker. Intravenously administered amiodarone causes heart block or bradycardia in 4.9 percent of patients and hypotension in 16 percent.

When should you not take amiodarone? ›

Avoid amiodarone in patients with significant conduction system disease, significant liver or pulmonary disease, or hyperthyroidism. Regular monitoring of the patient, clinically and biochemically, is required to identify complications at an early, treatable stage.

At what heart rate should you hold amiodarone? ›

Hold the medication if HR < 60/min or > 120/min.

Ask the patient how s/he is feeling (e.g., lightheadedness, dizziness, chest pain, dyspnea). Assess other vital signs like blood pressure and respirations. Check cardiac monitor for presence of dysrhythmias.

What medications can trigger AFib? ›

New-onset AF has been associated with cardiovascular drugs such as adenosine, dobutamine, and milrinone. In addition, medications such as corticosteroids, ondansetron, and antineoplastic agents such as paclitaxel, mitoxantrone, and anthracyclines have been reported to induce AF.

How can I calm my atrial fibrillation at home? ›

Deep, Mindful Breathing
  1. Sit quietly and close your eyes.
  2. Put one hand on your belly.
  3. Breathe in slowly through your nose, feeling your stomach stretch out.
  4. Breathe out slowly through your mouth. Repeat.
Mar 9, 2021


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