From the Guidelines
Atrial fibrillation with rapid ventricular response (AFib with RVR) is most commonly triggered by cardiac conditions, acute illnesses, lifestyle factors, electrolyte abnormalities, medications, stress, and structural heart changes, as supported by the most recent evidence from 1 and 1. The causes of new AFib with RVR can be multifactorial, including:
- Cardiac conditions like coronary artery disease, heart failure, valvular heart disease, and hypertension
- Acute illnesses such as pneumonia, pulmonary embolism, sepsis, and thyrotoxicosis
- Lifestyle factors including excessive alcohol consumption, stimulant use, and caffeine
- Electrolyte abnormalities, particularly hypokalemia and hypomagnesemia
- Medications like sympathomimetics, theophylline, and certain antiarrhythmics
- Stress, both physical and emotional, leading to catecholamine surges
- Structural heart changes such as left atrial enlargement, often due to chronic hypertension or heart failure
- Sleep apnea, as nocturnal hypoxemia and sympathetic activation can trigger arrhythmias According to 1, aggressive management of underlying triggers is essential in postoperative AFib management, and medications that block atrioventricular nodal conduction, such as beta blockers or calcium channel blockers, can be used for ventricular rate control. It is also important to note that the management of AFib with RVR typically involves rate control with beta-blockers, calcium channel blockers, or digoxin, while addressing the underlying cause to prevent recurrence, as recommended by 1 and 1. The most recent and highest quality study, 1, highlights the importance of considering drug-induced atrial fibrillation, which can be caused by various medications, including cardiovascular, non-cardiovascular, and anticancer drugs. Overall, the management of AFib with RVR requires a comprehensive approach, taking into account the underlying causes and individual patient factors, as emphasized by 1 and 1.
From the Research
Causes of New Atrial Fibrillation with Right Ventricular Dysfunction
- Right ventricular (RV) dysfunction plays a significant role in the development of new-onset atrial fibrillation (AF) 2, 3
- The relationship between RV dysfunction and AF is bidirectional, as AF may be one of the causes of RV dysfunction, and their coexistence worsens the overall patient prognosis 2
- RV dysfunction is a strong predictor of developing AF in acutely decompensated heart failure patients, with a significant increase in cardiac readmission and mortality 3
- The presence of RV dysfunction, left atrial dilation, and left ventricular hypertrophy are strong predictors for AF 3
Predictors of Atrial Fibrillation
- Older age, history of heart failure, left atrial dilation, left ventricular hypertrophy, and RV dysfunction are predictors of AF 3
- RV dysfunction remains the strongest predictor of AF even after controlling for left atrial size and left ventricular hypertrophy 3
Clinical Implications
- The coexistence of chronic heart failure and AF can lead to hemodynamic compromise and worsen prognosis in patients with chronic RV failure 4
- RV function analysis by echocardiography can further risk-stratify patients based on their rhythm, categorizing those with abnormal RV and AF as having the worst prognosis 3