From the Guidelines
New onset atrial fibrillation with rapid ventricular response (AFib with RVR) is most commonly caused by cardiac conditions such as coronary artery disease, heart failure, valvular heart disease, and hypertension, as well as non-cardiac causes like hyperthyroidism, pulmonary diseases, and electrolyte abnormalities. According to the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, various factors can contribute to the development of AFib with RVR.
Common Causes
- Cardiac conditions: coronary artery disease, heart failure, valvular heart disease (particularly mitral valve disease), and hypertension
- Non-cardiac causes: hyperthyroidism, electrolyte abnormalities (especially hypokalemia and hypomagnesemia), alcohol consumption (holiday heart syndrome), stimulant use (including caffeine, cocaine, and amphetamines), and acute infections or inflammatory states
- Pulmonary conditions: pneumonia, pulmonary embolism, and COPD exacerbations
- Other factors: stress, surgery, and certain medications
Underlying Conditions
The guideline highlights the importance of identifying and treating underlying conditions, such as hypertrophic cardiomyopathy, AF complicating acute coronary syndrome (ACS), hyperthyroidism, pulmonary diseases, and heart failure 1.
Management
When evaluating new onset AFib with RVR, it's essential to identify and treat these underlying causes while simultaneously managing the arrhythmia with rate control medications (beta-blockers, calcium channel blockers), rhythm control if appropriate, and anticoagulation to prevent thromboembolic complications based on stroke risk assessment 1.
From the Research
Causes of New Onset Atrial Fibrillation with Rapid Ventricular Response (RVR)
There are no direct research papers provided that discuss the causes of new onset atrial fibrillation with RVR. However, the provided studies discuss the management and treatment of atrial fibrillation with RVR.
Management and Treatment of Atrial Fibrillation with RVR
- The management of atrial fibrillation with RVR involves rate or rhythm control, with the goal of preventing complications such as hypoperfusion and cardiac ischemia 2.
- Emergent cardioversion is indicated in hemodynamically unstable patients, while rate control using beta blockers or calcium channel blockers is pursued in hemodynamically stable patients 2.
- Studies have compared the effectiveness of different medications, including metoprolol and diltiazem, in controlling heart rate in patients with atrial fibrillation and RVR 3, 4, 5.
- A comprehensive umbrella review of systematic reviews and meta-analyses found that intravenous diltiazem was more successful in rate control for atrial fibrillation with RVR than intravenous metoprolol 5.
Comparison of Medications for Atrial Fibrillation with RVR
- A study found that diltiazem effectively controlled heart rate quicker than metoprolol, with greater heart rate reductions at 30 minutes and 60 minutes 3.
- Another study found that metoprolol had a lower failure rate than amiodarone and was superior to diltiazem in achieving rate control at 4 hours 4.
- The umbrella review found that intravenous diltiazem led to a significantly greater reduction in ventricular rate, but also increased the risk of hypotension 5.