EKG

Accelerated Idioventricular Rhythm

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Accelerated Idioventricular Rhythm, AIVR, Ventricular Escape Rhythm

  • Mechanism
  1. Benign transient Dysrhythmia (typically lasts minutes and resolves)
  2. Occurs after STEMI with coronary reperfusion (spontaneous or after PCI, Fibrinolysis)
  • Findings
  1. Regular wide complex rhythm (at least 3 consecutive beats)
  2. No P Waves (or P Waves with atrioventricular dissociation)
  3. Heart Rates typically 40 to 120 bpm
  • Differential Diagnosis
  1. See Wide Complex Tachycardia
  2. Ventricular Tachycardia
    1. Typically presents with Heart Rates >120-130
  3. Other causes
    1. Digoxin Toxicity
    2. Electrolyte abnormalities (e.g. Hyperkalemia)
    3. Cardiac ischemia
  • Management
  1. Observation of suspected AIVR rhythm only
  2. Antidysrhythmic medications may degenerate AIVR to Asystole
  • References
  1. Berberian and Brady (2024) Crit Dec Emerg Med 38(3): 15