Diferencia entre revisiones de «Accelerated idioventricular rhythm»

Revisión actual - 10:59 22 mar 2026

Background

Conduction system of the heart.

Results when rate of an ectopic ventricular pacemaker exceeds sinus node^[1]
Usually benign,self limiting
Terminology
- Idioventricular rhythm: 20-40 bpm
- Accelerated idoventricular rhythm: 40-120 bpm
- Ventricular tachycardia: >120 bpm

Causes

Reperfusion phase of acute myocardial infarction (most common cause)
Beta-sympathomimetics (isoprenaline or adrenaline)
Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane
Electrolyte abnormalities
Cardiomyopathy
congenital heart disease
myocarditis
Return of spontaneous circulation (ROSC) following cardiac arrest
Athletic heart

Clinical Features

Asymptomatic or palpitations

Differential Diagnosis

Wide-complex tachycardia

Assume any wide-complex tachycardia is ventricular tachycardia until proven otherwise (it is safer to incorrectly assume a ventricular dysrhythmia than supraventricular tachycardia with abberancy)

Regular
- Monomorphic ventricular tachycardia
- PSVT with aberrant conduction:
  - PSVT with bundle branch block^
  - PSVT with accessory pathway
  - Atrial flutter with bundle branch block^
- Sinus tachycardia with bundle branch block^
- Accelerated idioventricular rhythm (consider if less than or ~120 bpm)
- Metabolic
  - Hyperkalemia
  - Digoxin toxicity
  - Severe metabolic acidosis
Irregular
- Atrial fibrillation/atrial flutter with variable AV conduction AND bundle branch block^
- Atrial fibrillation/atrial flutter with variable AV conduction AND accessory pathway (e.g. WPW)
- Atrial fibrillation + hyperkalemia
- Polymorphic ventricular tachycardia
  - Torsades de pointes
  - Nonsustained ventricular tachycardia

^Fixed or rate-related

Palpitations

Arrhythmias:
Non-arrhythmic cardiac causes:
Psychiatric causes:
Drugs and Medications:
- Alcohol
- Caffeine
- Drugs of abuse (e.g. cocaine)
- Medications (e.g. digoxin, theophylline)
- Tobacco
Misc

Evaluation

Accelerated idioventricular rhythm (AIVR) at a rate of 55/min presumably originating from the left ventricle (LV). Note the typical QRS morphology in lead V1 characteristic of ventricular ectopy from the LV. Monophasic R-wave with smooth upstroke and notching on the downstroke (i.e., the so-called taller left peak or "rabbit-ear".)

ECG features

Regular rhythm
Rate 50-110 bpm
Three or more ventricular complexes
QRS complexes >120ms
Fusion and capture beats

Management

AIVR is a benign rhythm in most settings and does not usually require treatment
Self limiting and resolves when sinus rate exceeds that of the ventricular foci
Antiarrhythmics may cause precipitous haemodynamic deterioration and should be avoided
Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion
Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction

Disposition

Normally outpatient

External Links

LITFL - Accelerated Idioventricular Rhythm (AVIR)

References

↑ Ljubas Perčić D, et al. Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature. BMC Cardiovasc Disord. 2023 Jan 20;23(1):37. PMID 36670379

Authors:

[1] Ljubas Perčić D, et al. Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature. BMC Cardiovasc Disord. 2023 Jan 20;23(1):37. PMID 36670379

[1]

@@ Línea 1: / Línea 1: @@
-===Background===
+==Background==
-AIVR results when rate of an ectopic ventricular pacemaker exceeds sinus node.
+[[File:SinusRhythmLabels.svg|thumb]]
-Usually benign,self limiting
+[[File:ConductionsystemoftheheartwithouttheHeart-en.png|thumb|Conduction system of the heart.]]
+*Results when rate of an ectopic ventricular pacemaker exceeds sinus node<ref>Ljubas Perčić D, et al. Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature. BMC Cardiovasc Disord. 2023 Jan 20;23(1):37. PMID 36670379</ref>
+*Usually benign,self limiting
+*Terminology
+**Idioventricular rhythm: 20-40 bpm
+**Accelerated idoventricular rhythm: 40-120 bpm
+**Ventricular tachycardia: >120 bpm
 ===Causes===
-#Reperfusion phase of acute myocardial infarction (= most common cause)
+*Reperfusion phase of [[acute myocardial infarction]] (most common cause)
-#Beta-sympathomimetics (isoprenaline or adrenaline)
+*Beta-sympathomimetics (isoprenaline or adrenaline)
-#Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane
+*Drug toxicity, especially [[digoxin]], [[cocaine]] and volatile anaesthetics such as desflurane
-#Electrolyte abnormalities
+*[[Electrolyte abnormalities]]
-#Cardiomyopathy, congenital heart disease, myocarditis
+*[[Cardiomyopathy]]
-#Return of spontaneous circulation (ROSC) following cardiac arrest
+*[[congenital heart disease]]
-#Athletic heart
+*[[myocarditis]]
-===ECG features===
+*Return of spontaneous circulation ([[ROSC]]) following [[cardiac arrest]]
-#Regular rhythm.
+*Athletic heart
-#Rate 50-110 bpm.
-#Three or more ventricular complexes.
+==Clinical Features==
-#QRS complexes >120ms.
+*Asymptomatic or [[palpitations]]
-#Fusion and capture beats.
-===Management===
+==Differential Diagnosis==
-#AIVR is a benign rhythm in most settings and does not usually require treatment.
+{{Tachycardia (wide) DDX}}
-#Self limiting and resolves when sinus rate exceeds that of the ventricular foci.
+{{Palpitations DDX}}
-#Anti-arrhythmics may cause precipitous haemodynamic deterioration and should be avoided.
-#Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion.
+==Evaluation==
-#Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction.
+[[File:AIVR from the LV.png|thumb|Accelerated idioventricular rhythm (AIVR) at a rate of 55/min presumably originating from the left ventricle (LV). Note the typical QRS morphology in lead V1 characteristic of ventricular ectopy from the LV. Monophasic R-wave with smooth upstroke and notching on the downstroke (i.e., the so-called taller left peak or "rabbit-ear".)]]
-===Refereces===
+===[[ECG]] features===
-http://lifeinthefastlane.com/ecg-library/aivr/
+*Regular rhythm
+*Rate 50-110 bpm
+*Three or more ventricular complexes
+*QRS complexes >120ms
+*Fusion and capture beats
+==Management==
+*AIVR is a benign rhythm in most settings and does not usually require treatment
+*Self limiting and resolves when sinus rate exceeds that of the ventricular foci
+*[[Antiarrhythmics]] may cause precipitous haemodynamic deterioration and should be '''avoided'''
+*Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion
+*Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case [[atropine]] may be trialled to increase sinus rate and AV conduction
+==Disposition==
+*Normally outpatient
+==See Also==
+*[[ECG]]
+==External Links==
+*[http://lifeinthefastlane.com/ecg-library/aivr/  LITFL - Accelerated Idioventricular Rhythm (AVIR)]
+==References==
+<references/>
+[[Category:Cardiology]]