Slow ventricular response

[50568789]

This was the narrative on my recent ecg for a paroxysmal AF flare which has just gone into a 10th continuous day, normally up to 3 days. Nobody seems too bothered, GP described it as well controlled, and it's certainly milder than usual. Just that I wasn't familiar with the title description and wonder if someone can give me a layman's translation? (Now on a countdown to ablation mid June).

[Jalia]

I can only compare to my readings which are given as AF with a rapid ventricular response. My rates are fast .....these days 130/ 160+ which I can't stay in for too long and usually require The Electrics! I would imagine that your rate is more normal and manageable. (I also have ablation booked next month...my 5th)

[50568789 in reply to Jalia]

5? Oh good grief. Hope it works well for you, this is my first.

[Jalia in reply to 50568789]

Ha! Yes.....if I knew I was going to need 5 before I had my first one I would have collapsed on the spot. Its been quite a journey.

Good luck with your ablation

[Buffafly]

I think it means AF below 100 bpm - ie same a normal rate

[Ppiman]

So long as you are anti-coagulated, I wonder if it isn't better to have AF with SVR than the more usual RVR? I don't know the answer.

From what I have read, it's unusual for the ventricles, via the AV node, to respond in the way yours has, though, with, it seems, under 10% of people responding this way. My AF is typically in the range of 85-135bpm, for example, sometimes up to 160, or even 180bpm.

The AV node is the ventricular “pacemaker” which normally, in health, takes its signal from the primary natural pacemaker in the right atrium, the SA or sino-atrial node. This beats, when the body is resting, at around 70-80bpm and the ventricles shortly after follow suit.

In AF, however, the left atrium is in a quivering state of ~600bpm and, sadly, is now not only vibrating away chaotically, it is also able to send a raft of its own “competing” electrical signals down to the AV node alongside the proper ones coming from the SA node. The AV node, in most cases, allows too many of these aberrant signals through, resulting in palpitations and “AF with RVR” or tachycardia (i.e. a resting rate >100bpm).

In your case, the AV node is allowing far fewer signals through, but many of these, presumably (although I don’t know), are still AF aberrant ones rather than sinus generated healthy ones. This perhaps means that the symptoms will be less prominent as the left ventricle can still pump more as it should, to supply the oxygenated blood as required by the body. However, I’ve read that it might be that the SVR - although still a theory - can cause worse issues with the blood pooling in a part of the atrium called the left atrial appendage, meaning that there's an even greater need for anticoagulation than with RVR. You'll have this, of course, anyway, hence, I am presuming, the lack of concern from your surgery.

My elderly friend is like you and has never had RVR to his knowledge. He's now the grand age of 90 and doing well. He's been on warfarin since his AF started many years ago and, in general, he gets few symptoms. I think it's likely that had he not collapsed when his AF first started, he might never have discovered he had it and then not been given warfarin and, well... we needn't guess further. As it is, he is looking back on many years of near asymptomatic AF.

Steve

[50568789 in reply to Ppiman]

Thanks for your detailed reply. I'll re-read a few times to check if I understand it! I'm grateful at least that I don't have a high heart rate with it , but the light-headedness and shortness of breath is challenging at the moment and no sign of it abating.

[Ppiman in reply to 50568789]

I have had an afternoon of this with no AF only lots of ectopic beats. What a life we lead!

Steve