Choi James, Kong Darren, Katic Luka, Torelli Vincent A, Karpenos Joseph, Markovic Nebojsa, Mehta Davendra
Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside/West, New York, NY, USA.
Mount Sinai Heart, Mount Sinai Morningside/West, New York, NY, USA.
J Med Access. 2025 Jun 30;9:27550834251342890. doi: 10.1177/27550834251342890. eCollection 2025 Jan-Dec.
Atrial fibrillation is a common cardiac arrhythmia affecting over 33 million individuals globally; however, atrial fibrillation with slow-ventricular response (AF-SVR) remains an underexplored subset. AF-SVR is characterized by an irregular ventricular rate of less than 60 beats per minute without the influence of atrioventricular (AV) blocking agents. This review aims to consolidate current knowledge on AF-SVR, focusing on the epidemiology, pathophysiology, clinical manifestations, complications, diagnosis, and management strategies. AF-SVR is more prevalent in older adults, often attributed to age-related degeneration of the cardiac conduction system. Conditions such as AV nodal block, sick sinus syndrome (SSS), and the effects of certain medications are significant contributors to the development of AF-SVR. The pathophysiology involves complex electrical and structural remodeling of the atria, which can lead to bradycardia and symptomatic conduction delays. Clinically, AF-SVR presents similarly to other forms of bradycardia, with symptoms including fatigue, dizziness, and syncope. Diagnosis is primarily based on electrocardiogram (ECG) findings of AF with a slow-ventricular rate, supplemented by ambulatory ECG monitoring and exercise tolerance testing. Transthoracic echocardiography (TTE) is crucial for identification of underlying structural heart disease. Management of AF-SVR involves first addressing reversible causes such as medication effects, electrolyte imbalances, and underlying ischemia. Pharmacological options including the use of anticholinergic medications such as theophylline and hyoscyamine, which have shown efficacy in reversing bradycardia. Persistent or severe cases often require permanent pacemaker implantation to maintain adequate heart rates and prevent complications. This review highlights the need for further research on AF-SVR, particularly regarding non-invasive treatment options and the long-term outcomes of different management strategies. Understanding the unique challenges of AF-SVR is essential for optimizing patient care and improving clinical outcomes. Future studies should focus on establishing comprehensive guidelines for the diagnosis and management of AF-SVR.
心房颤动是一种常见的心律失常，全球有超过3300万人受其影响；然而，伴有缓慢心室反应的心房颤动（AF-SVR）仍是一个未得到充分研究的亚组。AF-SVR的特征是心室率不规则，每分钟少于60次，且不受房室（AV）阻滞剂的影响。本综述旨在整合关于AF-SVR的现有知识，重点关注其流行病学、病理生理学、临床表现、并发症、诊断和管理策略。AF-SVR在老年人中更为普遍，这通常归因于与年龄相关的心脏传导系统退化。房室结阻滞、病态窦房结综合征（SSS）等情况以及某些药物的作用是AF-SVR发生的重要因素。其病理生理学涉及心房复杂的电和结构重塑，这可导致心动过缓和有症状的传导延迟。临床上，AF-SVR的表现与其他形式的心动过缓相似，症状包括疲劳、头晕和晕厥。诊断主要基于房颤伴缓慢心室率的心电图（ECG）表现，并辅以动态心电图监测和运动耐量测试。经胸超声心动图（TTE）对于识别潜在的结构性心脏病至关重要。AF-SVR的管理首先要解决可逆性病因，如药物作用、电解质失衡和潜在缺血。药物选择包括使用抗胆碱能药物，如茶碱和莨菪碱，这些药物已显示出逆转心动过缓的疗效。持续性或严重病例通常需要植入永久性起搏器以维持足够的心率并预防并发症。本综述强调了对AF-SVR进行进一步研究的必要性，特别是关于非侵入性治疗选择和不同管理策略的长期结果。了解AF-SVR的独特挑战对于优化患者护理和改善临床结果至关重要。未来的研究应专注于制定AF-SVR诊断和管理的综合指南。
