From the Guidelines
No, a digital rectal exam cannot terminate atrial fibrillation with rapid ventricular response (AFib with RVR). This cardiac arrhythmia requires specific medical interventions rather than physical maneuvers like a rectal exam. For AFib with RVR, treatment typically includes rate-controlling medications such as beta-blockers (metoprolol 5-15mg IV), calcium channel blockers (diltiazem 0.25mg/kg IV), or in some cases digoxin, as recommended by the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1. In emergency situations, electrical cardioversion may be necessary. The vagal maneuvers that can sometimes slow heart rate in certain arrhythmias include carotid sinus massage or Valsalva maneuver, but these are not consistently effective for AFib with RVR and should only be attempted under medical supervision. A digital rectal exam stimulates different neural pathways and has no established effect on cardiac rhythm.
Some key considerations for managing AFib with RVR include:
- Urgent cardioversion for patients with hemodynamic compromise, ongoing ischemia, or inadequate rate control, as recommended by the 2014 AHA/ACC/HRS guideline 1
- IV beta blockers to slow RVR with ACS and no HF, hemodynamic instability, or bronchospasm, as recommended by the 2014 AHA/ACC/HRS guideline 1
- Anticoagulation with warfarin for patients with ACS and AF with CHA2DS2-VASc score ≥2, unless contraindicated, as recommended by the 2014 AHA/ACC/HRS guideline 1
- Beta blockers or nondihydropyridine calcium channel antagonists for persistent or permanent AF in patients with HFpEF, as recommended by the 2014 AHA/ACC/HRS guideline 1
If experiencing symptoms of AFib with RVR (rapid irregular heartbeat, shortness of breath, chest discomfort), one should seek immediate medical attention rather than attempting self-treatment. The most recent and highest quality study, the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation 1, provides the basis for these recommendations, prioritizing morbidity, mortality, and quality of life as the outcome.
From the Research
Digital Rectal Exam and Atrial Fibrillation
- A digital rectal exam has been reported to convert atrial fibrillation (AF) to sinus rhythm in a 29-year-old male with no cardiovascular history 2.
- This case report suggests that vagal maneuvers, such as a digital rectal exam, can increase vagal tone and potentially convert AF to sinus rhythm.
- However, this is a single case report and more research is needed to confirm the effectiveness of digital rectal exams in converting AF to sinus rhythm.
Management of Atrial Fibrillation with Rapid Ventricular Response
- The management of AF with rapid ventricular response (RVR) typically involves rate or rhythm control using medications such as beta blockers or calcium channel blockers 3, 4, 5.
- Cardioversion is also an option for patients with hemodynamically unstable AF or those who do not respond to medication 3, 5.
- The choice of medication for rate control depends on the individual patient's clinical situation and comorbidities 4.
Effectiveness of Digital Rectal Exam in Converting AF to Sinus Rhythm
- There is limited evidence to suggest that a digital rectal exam can terminate AF with RVR 2.
- More research is needed to confirm the effectiveness of digital rectal exams in converting AF to sinus rhythm and to determine the underlying mechanisms by which this occurs.
- Currently, digital rectal exams are not a standard treatment for AF with RVR, and other management strategies such as medication and cardioversion are typically used 3, 4, 5, 6.