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Rate Control in Atrial Fibrillation with RVR

Michael Macias

Pollster was designed to ask the big questions in emergency medicine that all practicing EM physicians/personnel want to know! The goal is to use create extremely brief surveys and utilize social media to spread the word and gather as much data as possible! We will then use this data to generate info-graphics to make interpretation of the data easy, fun and lead to generation of new discussions! Check our previous pollster on 'Vasopressors in Septic Shock.' 

This week we want to know what you use for rate control in stable afib with RVR. What are you most likely to start first? We have included a specific case to help create a more tangible scenario. Would you cardiovert this patient? Would you start anticoagulation?

Have a learning pearl you want to share with regards to this topic? Want to discuss a bit of nuance regarding atrial fibrillation with RVR? Leave it in the additional comment box, we would love to know and share it! 

Atrial Fibrillation with Rapid Ventricular Response 


A 50 y/o gentleman with a past medical history of HTN presents with palpitations since last night. He notes that he was driving home from work when he first noticed them. He denies any chest pain or lightheadedness but does feel that he becomes short of breath with minimal activity which is new for him. Denies any new leg swelling.

His initial ECG reveals atrial fibrillation with a rate of 160 but is otherwise unremarkable. His rate on the monitor is varying from 150-170 bpm, his blood pressure is 145/85 and he is saturating 98% on room air. Other than his abnormal vitals, the patient appears quite well and his exam does not suggest frank heart failure. 

It has been 16 hours since his palpitations started, what do you want to do?


Thank you, we look forward to all of your responses!