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The commenters raise excellent points. We also share their perspective that several different disease processes can independently result in atrial fibrillation with rapid ventricular response. It is clinically important to distinguish the underlying etiologies in order to select the appropriate treatment. This author considers 3 physiologic states when faced with atrial fibrillation (Afib) with rapid ventricular response (RVR).

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Source(s) of support in the form of equipment, drugs, or grants (including grant numbers): None.

☆☆The name of organization and date of assembly if the article has been presented: American Society of Health-System Pharmacists 2014 Midyear Clinical Meeting; Anaheim, CA; December 7-11, 2014.

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