From the Guidelines
Atrial fibrillation (AFib) with a heart rate in the 80s would not be considered AFib with rapid ventricular response (RVR) for your patient with a congenital heart defect. AFib with RVR is typically defined as AFib with a ventricular rate greater than 100-110 beats per minute 1. A heart rate in the 80s falls within the normal range and would be considered controlled AFib. For patients with congenital heart defects, maintaining a controlled heart rate is particularly important as tachycardia can worsen cardiac function and increase symptoms 1. The specific heart rate target may vary depending on the type of congenital defect, the patient's symptoms, and their overall cardiac function. Management should focus on stroke prevention with appropriate anticoagulation based on their CHA₂DS₂-VASc score, along with rate control medications such as beta-blockers or calcium channel blockers if needed to maintain appropriate heart rates 1. Some key points to consider in the management of AFib in patients with congenital heart defects include:
- Oral anticoagulants are recommended for all patients with AF and intracardiac repair, cyanotic congenital heart disease, Fontan palliation, or systemic right ventricle irrespective of the individuals’ thromboembolic risk factors 1
- Rate control drugs such as selective beta-1 receptor blockers, verapamil, diltiazem, and digoxin can be used with caution, with monitoring for bradycardia and hypotension 1
- Rhythm control strategies such as amiodarone may be effective, but warrant monitoring for bradycardia 1 Regular monitoring is essential as patients with congenital heart defects may have different hemodynamic responses to AFib compared to those with structurally normal hearts 1.
From the Research
Atrial Fibrillation with Rapid Ventricular Rate in Patients with Congenital Heart Defects
- Atrial fibrillation (Afib) is a common arrhythmia in patients with congenital heart defects, with a rising incidence in the aging population 2.
- The age of onset of Afib in patients with congenital heart defects is relatively young, with a mean age of 49 ± 17 years 2.
- Regular atrial tachycardia (AT) coexisting with Afib occurs in a significant number of patients, with 65% initially presenting with regular AT 2.
- The progression from paroxysmal to persistent or permanent Afib is rapid, with 26% of patients deteriorating within 3 years of the first Afib episode 2.
Heart Rate and Atrial Fibrillation
- A heart rate in the 80s may not necessarily indicate the presence of Afib with a rapid ventricular rate (RVR), as Afib can present with a variety of ventricular rates 3.
- However, patients with congenital heart defects are at increased risk of developing arrhythmias, including Afib, due to residual problems and sequelae from their underlying condition 4.
Management of Atrial Fibrillation in Patients with Congenital Heart Defects
- The management of Afib in patients with congenital heart defects requires a multidisciplinary approach, taking into account the patient's underlying cardiac anatomy and physiology 5.
- Treatment options for Afib in this population include pharmacotherapy, electrical cardioversion, and catheter ablation, with the goal of controlling symptoms and preventing complications such as stroke and heart failure 5.