Heart Health Managing Symptoms of AFib With RVR By Angela Ryan Lee, MD Updated on April 30, 2024 Medically reviewed by Jeffrey S. Lander, MD Print Table of Contents View All Table of Contents Meaning of RVR In Cardiology Symptoms Risk Factors What If You Have AFib Without RVR? How Serious Is AFib With RVR? Diagnosis Treatment Living Well With AFib With RVR Frequently Asked Questions Atrial fibrillation (AFib) is an irregular heart rhythm (arrhythmia) that can lead to rapid heart rates and increase stroke risk. AFib with rapid ventricular rate (RVR) can cause symptoms ranging from fatigue to lightheadedness and fainting, increasing the risk of heart failure. AFib is the most common arrhythmia, affecting an estimated 3 to 6 million people in the United States. About 1 in every 3 to 5 people is expected to develop AFib in their lifetime. This risk is expected to increase in the coming years as our population is aging and accumulating more risk factors. This article will discuss symptoms, diagnosis, and management of AFib with RVR. Stefania Pelfini, La Waziya Photography / Getty Images Meaning of RVR In Cardiology The heart is made of four chambers: two upper chambers called the atria, and two lower chambers called the ventricles. Electrical signals in the atria cause the heart chambers to contract and beat to pump blood to the body. Heart rate is determined by the rate of ventricular contraction. In AFib, the atria rapidly beat due to erratic electrical signals. These signals are irregularly transmitted down to the ventricles and cause an irregular rapid ventricular heart rate (RVR). Symptoms AFib can be intermittent and it does not always cause symptoms, so some people may not know that they have Afib. Other people may experience symptoms ranging from mild to severe, including: Fatigue Heart palpitations (feeling of a racing or irregular heartbeat) Exercise intolerance Lightheadedness or dizziness Shortness of breath Chest pain Fainting Some symptoms of AFib can overlap with other serious and life-threatening conditions like a heart attack. If you are experiencing concerning symptoms, such as chest discomfort or difficulty breathing, seek medical attention immediately as these may be signs of a heart attack. Risk Factors AFib risk factors include: High blood pressureIncreasing ageHeart failureObesityDiabetesKidney diseaseAlcohol useTobacco useHyperthyroidism (when the thyroid gland makes too many hormones) What If You Have AFib Without RVR? AFib does not necessarily cause a rapid heart rate. Some people with AFib may have a slow or normal heart rate. In this case, there may or may not be symptoms, but increased risk of stroke still needs to be evaluated and addressed with your healthcare provider. How Serious Is AFib With RVR? AFib is a serious condition that increases the risk of stroke regardless of whether or not RVR is present. However, having Afib with RVR is even more serious. With a rapid heart rate, the heart's beating is inefficient and cardiac output can drop. When this happens, the heart is not supplying blood adequately to the body, whcih cause lack of blood flow to organs and the brain, leading to fainting and congestive heart failure. A chronically elevated heart rate can also lead to a type of heart failure called tachycardia-induced cardiomyopathy. Diagnosis AFib with RVR is diagnosed using an electrocardiogram (ECG). An ECG is a noninvasive test that picks up the heart's rhythm using electrodes placed on the chest. ECG can be performed at a healthcare provider's office or in a hospital. However, an ECG is just a snapshot of the heart's rhythm, and since AFib can come and go, a single ECG may not capture the abnormal rhythm. In this case, longer forms of monitoring are needed. A healthcare provider might order a patch monitor, a Holter monitor, or place an implantable loop recorder, which are all forms of ambulatory rhythm monitoring that can monitor the heart over longer periods of time. Nowadays, heart monitors on wearable devices smartwatches and trackers can pick up irregular rhythms like AFib and send alerts to the user. If you ever receive an alert like this from your device, it's a good idea to have it evaluated by a healthcare provider, even if you don't have any symptoms. Treatment Treatment of AFib can involve staying out of AFib (rhythm control), or controlling the heart rate (rate control). Both approaches also require attention to reduce the risk of stroke. Rhythm Control in AFib AFib can come and go (paroxysmal AFib) or be constant (persistent or permanent AFib). When a cardiologist determines that the best course of action is to stay out of AFib with rhythym contro, whether because of symptoms or complications like heart failure, a rhythm control strategy can include the following: Antiarrhythmic medications like Rythmol (propafenone) or Tambocor (flecainide) Electrical cardioversion Cardiac ablation Heart Control in Afib With RVR AFib with RVR can be a medical emergency, and in this case, electrical cardioversion and intravenous medications can be given to rapidly control heart rate and rhythm. In a non-emergency setting, staying in AFib while managing heart rates may be appropriate. In this case, oral medications to keep the heart rate in an acceptable range can be prescribed, including: Sodium channel blockers like Tambocor (flecainide) and Rythmol (propafenone) Calcium channel blockers, specifically non-dihydropyridine type, which includes Cardizem (diltiazem) In some cases, antiarrhythmic medications that have a rate-slowing effect, such as amiodarone or digoxin may be used to help control heartrate. Stroke Prevention in AFib One serious complication of Afib is stroke. AFib is estimated to be the cause of 1 in 4 strokes in people over the age of 80. Stroke can be life-threatening and disabling, and increase the risk of dementia. Stroke risk in AFib is higher when certain other conditions are present, like diabetes, heart failure, hypertension, increased age, and vascular disease. Your healthcare provider can discuss your risk of stroke and make recommendations on a treatment plan that includes taking a blood thinner to help lower your risk. Living Well With AFib With RVR AFib with RVR can cause a range of symptoms, but there are many treatment options available. Some people may only require controlling heart rate for symptom management. Or you may need a rhythm control strategy to help keep heart rhythm normal and allow you to continue exercise and activities without limitations. Controlling other heart disease and AFib risk factors is also beneficial and includes: Eating a healthy diet Controlling blood pressure, cholesterol, and blood sugar Maintaining a healthy weight Getting regular physical exercise Treating any sleep-disordered breathing Reducing alcohol intake Summary AFib with RVR is a serious condition that can cause various symptoms and increase the risk of stroke and heart failure. While many people have undiagnosed AFib, it can be easily diagnosed with noninvasive heart rhythm monitoring. Treatment includes controlling heart rate, making certain lifestyle changes, and taking medication. Frequently Asked Questions What is your heart rate with RVR? A normal heart rate is between 60 and 100 beats per minute (bpm). AFib with RVR is when atrial fibrillation causes a heart rate over 100 bpm. However, in Afib with RVR, heart rates can go much higher, leading to inefficient cardiac output and symptoms. What is a good heart rate to have with AFib with RVR? In people who are being managed with a heart rate control strategy, studies have shown that a lenient heart rate control of fewer than 110 beats per minute (bpm) is safe when compared to strict heart rate control, particularly in people with minimal symptoms and no heart failure. A stricter heart rate control strategy may be preferred in those with symptoms or heart failure. Medications like beta blockers and calcium channel blockers keep heart rate in the goal range. Learn More AFib Overview How long is too long for RVR to last? This depends on whether you have symptoms or not. A brief bout of RVR, especially when related to physical activity, is not necessarily going to cause problems. However, if you develop RVR and have symptoms, like chest pain, shortness of breath or fainting, it's time to seek medical attention right away. Chronically elevated heart rates in AFib can lead to heart failure. 11 Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of atrial fibrillation in the 21st Century: Novel methods and new insights. Circ Res. 2020;127(1):4-20. doi:10.1161/CIRCRESAHA.120.316340 American Heart Association: What are the symptoms of atrial fibrillation? Centers for Disease Control and Prevention. Atrial fibrillation. American Heart Association. Why atrial fibrillation matters. 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Lifestyle and risk factor modification for reduction of atrial fibrillation: A scientific statement from the American Heart Association. Circulation. 2020;141(16):e750-e772. doi:10.1161/CIR.0000000000000748 American Heart Association. All about heart rate. Van Gelder IC, Hobbelt AH, Mulder BA, Rienstra M. Rate control in atrial fibrillation: Many questions still unanswered. Circulation. 2015;132(17):1597-1599. doi:10.1161/CIRCULATIONAHA.115.018952 By Angela Ryan Lee, MD Dr. Lee is an Ohio-based board-certified physician specializing in cardiovascular diseases and internal medicine. See Our Editorial Process Meet Our Medical Expert Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit