Introduction
- Accelerated idioventricular rhythm (AIR) occurs in patients with underlying heart disease such as coronary artery disease, it commonly manifests in patients with myocardial infarction
- It can also occur in patients experiencing digoxin toxicity
- Onset of AIR is generally gradual and occurs when the rate of AIVR exceeds the sinus rate as a result of sinus slowing or sinoatrial (SA) or AV block
- Termination is also gradual and can happen due to slowing of the ventricular rate or acceleration of the sinus rhythm
- SA node and the ventricles compete for the role of leading pacemaker due to their similar rate, that produces capture beats and/or fusion beats
- It is usually transient lasting up to several minutes and can be recurrent
- It does not alter the patient’s prognosis
Causes
- Typical situation resulting in AIR is reperfusion of a blocked coronary artery such as during or after PCI for myocardial infarction
- Other causes/situations include resuscitation (during return of spontaneous circulation), electrolyte abnormalities, congenital heart disease, cardiomyopathies, myocarditis or drug effect (isoprenaline, norepinephrine)
ECG characteristics
- regular or irregular ventricular rhythm with a rate of 60-110/min
- > 3 consecutive wide (>120 ms) QRS complexes
- capture beats and fusion beats may be present
ECG 1 Accelerated idioventricular rhythm - a ventricular rhythm at a rate of 97/min, QRS duration is 136 ms, capture beats are present (last beat in limb and precordial leads)
Management
- Treatment is rarely necessary. If treatment is required (symptomatic patient, rate is too high,…) atrial pacing or atropine administration to accelerate the sinus rhythm can be considered
References
- Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 11th ed, Zipes DP, Libby P, Bonow RO, et al, W.B. Saunders Company, Philadelphia 2018.
- https://litfl.com/accelerated-idioventricular-rhythm-aivr/
Published by
Assoc. Prof. Michal Pazderník, MD, Ph.D. FESC
Introduction
- Accelerated idioventricular rhythm (AIR) occurs in patients with underlying heart disease such as coronary artery disease, it commonly manifests in patients with myocardial infarction
- It can also occur in patients experiencing digoxin toxicity
- Onset of AIR is generally gradual and occurs when the rate of AIVR exceeds the sinus rate as a result of sinus slowing or sinoatrial (SA) or AV block
- Termination is also gradual and can happen due to slowing of the ventricular rate or acceleration of the sinus rhythm
- SA node and the ventricles compete for the role of leading pacemaker due to their similar rate, that produces capture beats and/or fusion beats
- It is usually transient lasting up to several minutes and can be recurrent
- It does not alter the patient’s prognosis
Causes
- Typical situation resulting in AIR is reperfusion of a blocked coronary artery such as during or after PCI for myocardial infarction
- Other causes/situations include resuscitation (during return of spontaneous circulation), electrolyte abnormalities, congenital heart disease, cardiomyopathies, myocarditis or drug effect (isoprenaline, norepinephrine)
ECG characteristics
- regular or irregular ventricular rhythm with a rate of 60-110/min
- > 3 consecutive wide (>120 ms) QRS complexes
- capture beats and fusion beats may be present
ECG 1 Accelerated idioventricular rhythm - a ventricular rhythm at a rate of 97/min, QRS duration is 136 ms, capture beats are present (last beat in limb and precordial leads)
Management
- Treatment is rarely necessary. If treatment is required (symptomatic patient, rate is too high,…) atrial pacing or atropine administration to accelerate the sinus rhythm can be considered
References
- Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 11th ed, Zipes DP, Libby P, Bonow RO, et al, W.B. Saunders Company, Philadelphia 2018.
- https://litfl.com/accelerated-idioventricular-rhythm-aivr/
Published by
Assoc. Prof. Michal Pazderník, MD, Ph.D. FESC
