RVR

RVR (rapid ventricular response) occurs in the setting of atrial fibrillation when the AV node conducts multiple impulses from the chaotic atrial activity to the ventricles, resulting in a rapid, irregular ventricular rate often >130 bpm. Conditions increasing AV nodal conduction (sympathetic tone, fever, hyperthyroidism, acute illness, stimulant use) or decreasing the AV node's refractory period promote RVR. Hemodynamically, RVR reduces diastolic filling time, decreasing cardiac output and precipitating heart failure, angina, or syncope. Management depends on clinical stability: unstable patients require synchronized electrical cardioversion, while stable patients receive rate-control medications (beta-blockers, calcium channel blockers, or digoxin). Identifying and treating the underlying cause (thyroid disease, infection, PE) is essential; anticoagulation is indicated unless contraindicated to prevent stroke.