Why the study?
Management of atrial fibrillation with rapid ventricular response in the setting of heart failure requires clarification of the underlying condition driving the arrhythmia.
Case Report (n=1)
In patients presenting with atrial fibrillation and rapid ventricular response driven by acute heart failure, primary treatment should target the underlying heart failure rather than immediate cardioversion.
QRS axisApproximately 0° (normal in adult is -30 to +90°).QRS morphology: In V1: rsR' pattern.In V6, a qRs pattern with a normal skinny q wave, also seen in Lead I, and representing rapid septal depolarization.The s wave in V6 is shallow and broad / slurred.All these fi ndings are typical of Right Bundle Branch Block (RBBB). P wavesThe question is: are there any?In the rhythm strip, at slower rates, there does appear to be something that looks like a P wave in front of some of the QRSs but this is not a consistent fi nding.The last long R-R interval in aVL shows a number of waves of atrial activity that are not regular and variable.Hence, although there is atrial activity, there are no obvious regular P waves.
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Andrzej M. Okreglicki (2017) conducted a case report in Atrial fibrillation with rapid ventricular response and underlying right bundle branch block (n=1). Heart failure management (diuretics and nitrates) was evaluated.
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