Control of ventricular rate in atrial fibrillation: Nonpharmacologic therapy
- Leonard I Ganz, MD, FHRS, FACC
Leonard I Ganz, MD, FHRS, FACC
- Section Editor — Cardiac Arrhythmias
- Director of Cardiac Electrophysiology
- Heritage Valley Health System
In patients with atrial fibrillation (AF), the ventricular rate is controlled by the conduction properties of the atrioventricular node. In the typical patient with untreated AF, the ventricular rate can reach 150 beats/min or higher.
There are two important reasons to prevent a rapid ventricular response in patients with AF:
●Avoidance of hemodynamic instability and/or symptoms. (See "Hemodynamic consequences of atrial fibrillation and cardioversion to sinus rhythm".)
●Avoidance of a tachycardia-mediated cardiomyopathy. (See "Arrhythmia-induced cardiomyopathy".)
In patients with AF, a rapid ventricular response can be prevented either by restoring sinus rhythm or with therapies that reduce the ventricular response to AF. When rate control is chosen, it can usually be accomplished with pharmacologic therapy. However, some AF patients will respond poorly to or be intolerant of rate control medications. Options for such patients include reconsideration of a rhythm control strategy and nonpharmacologic methods to control the ventricular rate. (See "Overview of atrial fibrillation" and "Rhythm control versus rate control in atrial fibrillation".)
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- GENERAL PRINCIPLES
- Determinants of ventricular rate
- Adequacy of rate control
- AV NODAL ABLATION
- Outcomes and quality of life
- Pacemaker selection
- - Single chamber ventricular pacemaker
- - Dual chamber pacemaker
- - Cardiac resynchronization therapy
- - Implantable cardioverter-defibrillators
- Postablation risk of VF and pacing rates
- Need for anticoagulation
- AV NODAL CONDUCTION MODIFICATION
- INVESTIGATIONAL METHODS
- Para-Hisian pacing
- Low atrial isolation
- Ventricular rate regularization
- Gene therapy
- SUMMARY AND RECOMMENDATIONS