Emergency medicine updates: Atrial fibrillation with rapid ventricular response.

Atrial fibrillation (AF) may lead to stroke, heart failure, and death. When AF occurs in the context of a rapid ventricular rate/response (RVR), this can lead to complications, including hypoperfusion and cardiac ischemia. Emergency physicians play a key role in the diagnosis and management of this dysrhythmia. This paper evaluates key evidence-based updates concerning AF with RVR for the emergency clinician. Differentiating primary and secondary AF with RVR and evaluating hemodynamic stability are vital components of ED assessment and management. Troponin can assist in determining the risk of adverse outcomes, but universal troponin testing is not required in patients at low risk of acute coronary syndrome or coronary artery disease - especially patients with recurrent episodes of paroxysmal AF that are similar to their prior events. Emergent cardioversion is indicated in hemodynamically unstable patients. Rate or rhythm control should be pursued in hemodynamically stable patients. Elective cardioversion is a safe option for select patients and may reduce AF symptoms and risk of AF recurrence. Rate control using beta blockers or calcium channel blockers should be pursued in those with AF with RVR who do not undergo cardioversion. Anticoagulation is an important component of management, and several tools (e.g., CHA An understanding of the recent updates in the literature concerning AF with RVR can assist emergency clinicians in the care of these patients.

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Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None. The authors of this review will not be submitting a manuscript on AF with RVR to another journal until AJEM makes a decision to reject or actually publishes (not just accepts) this manuscript. No AI program was utilized in the construction of this manuscript.