AF with RVR
I've just recently read something about AF with RVR. I hadn't come across this before, which surprised me, as I spent so much time looking up and researching Afib. Does it just mean that any Afib sufferer with a pulse over >100, when in Afib, has AF with RVR. When I've been in AF, my pulse rate has been rapid - sometimes as high as 180bpm but I have never been told that this is AF with RVR. Would really appreciate some help with this one. Thank you
My case notes were often written up as AF with RVR ....rapid ventricular rate. So yes that is Atrial fibrillation over 100
Thanks Jalia. So, does that mean that AF without the rapid heartbeat doesn't really require treatment? I'm not sure how anyone would even know they were in AF if their pulse rate was within normal range 🤔 I don't recall ever seeing RVR on any notes, though I know my pulse rate was really high.
Many people do not know that they have AF because they don’t have RVR and they are the ones probably most at risk of AF induced stroke. That’s why the AFA campaign for screening for AF in GP clinics.
Primary treatment for AF are stroke risk assessment and treatment and everything else is assessed on need for treatment if there are underlying causes or to improve quality of life ie: drugs/ablation/pacemaker.
Many people live with AF and it doesn’t cause them any difficulty whilst others with Paroxysmal AF with high heart rate find themselves incapacitated and struggle.
Thanks for the info CDreamer - just really surprised I've never been told this or had it in my notes
CDreamer has explained. No I don't usually get RVR on my notes either and wondered what it was first time.
My husband is an example of someone with permanent AF but under 100bpm. He wouldn't have been any the wiser had I not used my Kardia device on him when I became suspicious when he was on a course of Naproxen. Consequently he was put on anticoagulant.
I have since had request from cardiologist for a copy of his reading from my Kardia so you can see how useful these devices can be!
Also, from what I've recently been reading, Afib with RVR requires treatment because it is more likely to cause heart failure than non-RVR so I am surprised that some advice I've been given is to sit out episodes at home, rather than going to get treatment. I had no idea that it is more likely to cause heart failure. More info needs to be given by the experts methinks
I'm no medic Spangle but it is usually safe to sit out AF at home unless you are experiencing chest pains, breathing difficulties or faintness. I don't think heart failure would suddenly come on in hours. At the end of the day, whether or not you decide to go to A&E is your decision. It affects us all differently. It's your body and you know how you feel.
Personally , when I had a high sustained rate which made me feel compromised I opted to go to A&E , indeed was advised to do so and was always told there that it was the correct thing to do.
After saying all that and without going into the details I did go into heart failure ( pulmonary oedema ) after 3 weeks in AF...circa 120/130bpm. I was in a bad way. I was treated in hospital over a few days with diuretics and all was resolved. It was this episode which finally made me agree to my first RF ablation in 2009. I was reluctant to opt for ablation previously.
Absolutely agree Jalia that it is a personal decision, the point I was trying to make is that certain information could influence that choice and if you've never been given that information.....On the occasions I have experienced AF, it has always come with a very high rate - between 160 and 189 but it wasn't accompanied with any chest pain. The first time it happened, I really panicked asI didn't know what was going on and that probably didn't help my heart rate!
Reading what I read recently about Afib with RVR concerned me because my experience of Afib has only ever been with a high heart rate and while I agree and hope that that wouldn't mean going into heart failure there and then, I still think that I need the information to inform my decision, as without getting the rate down as quickly as possible is more likely to compromise the heart. Perhaps it's something that I should have realised but when you are told that you can 'sit it out' at home by cardiologists and arrhythmia nurses, it doesn't really give the impression that it could do damage in the long term. Obviously going to hospital for a fast rate means that there are more tools and procedures that can be used to bring the rate down, which people aren't able to access at home.
It depends a bit on how high the rate is and how long it goes on for. That’s why you need to go to A&E if you have chest pain, faintness etc, so the rate can be reduced otherwise your brain can be starved of oxygen and your heart overworked. Permanent AF at a lower rate can have the same effect, which is why doctors concentrate on rate while patients just want the wobbles stopped 💓🙂
My AF with RVR was so out of controll that I had to have a pacemaker and AV node ablation.Done in Oct 2020 am now waiting for Biventricular pacing for my heart failure
HI Carter52 despite amiodarone and 7.5mg bisoprolol my AF still refuses to settle down and the Cardiologists are now discussing AV node ablation ( I have previously had 4 ablations ) . I am really concerned about this - apparently you still have AF but the lower chambers are paced to work normally . Can you still feel the AF ? What happens if the battery / fails ?? Any other comments / advice would be helpful
Hi,yes you can still get a high heart rate but very seldom,I had 247 rate when I had Covid!!!!Having additional pacemake as my heart failure is much worse.Overall glad I had the AV node ablation as it has kept me out of hospital
Can you please tell me about the pacemaker and the AV node if it has worked and how you are feeling any AFIB now medication you take I am from Greece thank you
I feel so much better since Ihad the AV node ablation.Despite two ablations and trying every medication my heart "did it's own thing" I had covid three weeks after my av ablation and was in hospital quite ill was was'nt sure how I would feel afterwards.Once covid recovery took place I realised how nice not to be in hospital evey other week.Unfortunatly heart failure got worse but I am 84 with a head that is still in it's fifties!!!!!!!!I have a dual chamber pacemaker but within the next four weeks I go for RCT and hope I feel like a new woman
I had longstanding diagnosis of AFIB .... recently it returned in late 2020 as AF with additional RVR diagnosis. Apparently there is a difference.
With AF, I had high heart rate, but it was jumpy and uncoordinated. With AF and RVR, I would have separate episodes similar to AF ... but I also had episodes of normal 'sinus-like' heartbeats between 125- and 135-bpm that went on for hours. Or I went to bed normal and awoke in the morning with sustained high heart rate, but not AF.
So in summary, traditional AF was jumpy with high rate. RVR is high, sustained almost normal beats. Perhaps I had AF and RVR jumbled together, too, in same episode.
Hope that helps ................ In any event, I was told an ablation would 'cure' both of the arrhythmias. And that has certainly been the case for the past 15 months.
As it was explained to me, there are several kinds of AF with the two main ones being AF with RVR (rapid ventricular rate) and AF with CVR (controlled ventricular rate). The difference between these two types being the resting heart rate or pulse, with RVR being over 100. These two types of AF can be sub-categorised into paroxysmal (i.e. occurring in bouts) or persistent (i.e. occurring continually); a third sub-category is permanent AF, which is when persistent AF becomes uncontrollable even by medical intervention.
It is because the atria in all forms of AF are beating or quivering at up to 600bpm that micro-thrombi can form in the atria, leading to an increased risk of stroke; secondarily, the heart muscle itself, and the valves, are put at extra risk of being weakened by RVR and much more so when this is persistent or permanent.
Symptoms such as anxiety, breathlessness, light-headedness and weakness, can arise from the high heart rate, from a weakened heart, or from the reduced filling capacity of the ventricles which has been brought to rely on gravity and the suction created by the ventricular contractions.
Steve
Thank you Steve, so, if I have interpreted what you're saying correctly, if my resting heart rate is generally normal (circa 60-70bpm) and the only time it goes higher is when I am climbing stairs, walking briskly etc, or when I've gone into AF (when it has tended to go really high), it is not likely that I have Afib with RVR?
No, RVR means only that you have a pulse rate over 100bpm (which is more often called "tachycardia"). If you have this rate when you go into AF, then you have "AF with RVR" (although that is often labelled only as "AF", whereas AF can occur at any pulse (i.e. ventricular) rate.
My AF, which is quite unusual for me thankfully and didn't start (so far as I know) until after my ablation for atrial flutter in 2019, tends to occur at a pulse rate of 85-130. I also regularly get this rate without AF, and sometimes also without AF but with runs of palpitations, instead. Symptom-wise, all three feel the same and, luckily, apart from the anxiety, are physically not too bad and are controllable with a small dose (1.25mg) of bisoprolol.
Steve
Thanks Steve, it is making a bit more sense to me now and my AF has definitely been with RVR
I have a question, if I understand correctly, you have had an AV node ablation and pacemaker? You still take medication to control your rate as well?
Hi Spangle14.
AF is classed as an AF with persistent rapid irregular heart beat
or same but in episodes
or AF with slow irregular heart beat.
The most dangerous one is the first which I have and it needs to be controlled.
An ECG and a 24hr Heart Monitor will tell averages day and night.
I had 186 avg under exertion on metropolol. Sweating profusely from face, breathless and no energy.
I demanded a Heart Specialist who changed meds to Bisoprolol. HR now avg 156.
Still not under control. Night 48 though.
Advised mby Locum to go private.
I did and I am now controlled with a Calcium Channel Blocker added and beta blocker reduced.
120mg Diltiazem a.m and 2.5mg Bisoprolol at night.
HR day avge 93 and night 48hbm.
This is my balance and contrary to how Specialist thought I would be taking meds. 360mg CCB Diltiazem is top dose but with me even 180mg was too much.
You need to state how you feel.
I dont feel the racing when I exert myself but I was helped too in reducing PRADAXA to 110mg twice a day.
So things are looking up.
2019 Stroke showing above AF. Then 3 days later a carotid arteries scan showed a diagnosis of papillary thyroid cancer. Removed Feb 2020 but heart did not revert to normal.
Take care and do manage your own health with knowledge from various plaaces and Drs etc but you make up your mind tp monitor drugs etc. Cheri
You ask how someone with AF which is not at fast heart rate can tell they have it. From experience I can tell you.
Instead of the undetectable Rolex ticking away, a jazz drummer takes up residence in your chest. He thumps and bangs and won't be ignored.
You don't need a fast rate to be acutely aware of that!
I am acutely aware of the fast heart rate and thumping in my chest when in an Afib episode - it is, why I was carted off to A&E when it first happened to me. I can also imagine that someone with a much slower, but irregular heart rate could feel a thumping in their chest. My question was more to do with when Afib is considered to be Afib wit RVR.
Basically it just means you have a high heart rate, fast pulse, when in AFib.
Web MD's description (link at the end) is straightforward but comprehensive. After15 years of it since age 51 with no treatment until just over 6 years ago when I was prescribed bisoprolol 2.5mgs, and edoxaban 60mgs less than 2 years ago, I'd advise determinedly seeking the most effective treatment you can get.
AF is normally progressive (AF begets AF) and can lead to heart failure, valve damage, enlarged heart, increased risk of stroke and heart attack, and, according to recent research a much increased risk of dementia (esp for those who developed AF early - 50s and earlier; there are several research papers out there covering this). Anti-coagulants reduce the risk but don't neutralise it.
I'm comparably fit, active, not overweight, I don't drink, and I eat reasonably healthily but I've gone from a situation where my episodes were fairly short - 4 to 6 hours long - and infrequent - 5 to 10 per year - to the point where I've had 10 episodes of up to 14 hours each since 25th January this year. And the pattern can change quickly. Having averaged only 8 episodes per year during 2018/19/20 (a very welcome reduction from 22 in 2015) I had 17 last year before this year's dramatic worsening. I'm aware that everyone is different and the trajectory of each case varies, but for me personally this affliction is an increasing blight on my life in numerous ways.
I've read on here many times that AF won't kill you. That's a very pollyanish position imv. Any of its consequences (listed above) may act to shorten your life considerably. Only the survivors are able to comment on here, so I suspect the comments sample isn't representative of all AF sufferers/victims. This isn't meant to increase anyone's anxiety/fears, but to encourage them to take this affliction very seriously, and to ignore the complacent few amongst medical professionals. webmd.com/heart-disease/atr...
PS. It's true that some people with AF may not be aware of it (whether it's with RVR or not) until it's picked up by chance, but the main reason for this appears to be their low heartbeat awareness. Some people are aware of almost every heartbeat; others never feel it pumping away, whether it's arrythmic or not.
Af
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