202406262148
Status:
Tags: ECG
Accelerated idioventricular rhythm
ventricular rhythm up to 120bpm (from Chou's & Hurst's)
- Accelerated idioventricular rhythm (AIVR) is a relatively benign reperfusion arrhythmia
- Suggests successful reperfusion (partial or complete) of an occluded coronary vessel in AMI (spontaneous or s/p thrombolytics)
- Other presentations: digoxin toxicity, severe electrolyte abnormalities, cardiac ischemia
- May be seen during cardiac arrest resuscitation
- Unlikely to cause hemodynamic instability
- Suppression can cause instability
- → avoid antiarrhythmic medications (lidocaine, amiodarone, procainamide, etc.) which can cause asystole
- Tends to be transient. Treatment is to simply observe!
- When occurring spontaneously, strongly consider cath!
Ventricular rhythms
- Wide QRS complex rhythm with no P-waves or no P-QRS association (look closely at lead V1)
- Ventricular rate 20-40: ventricular escape rhythm (idioventricular rhythm)
- Ventricular rate 40-120s: Accelerated ventricular escape rhythm (accelerated idioventricular rhythm, AIVR)
- Ventricular rate > 120s-130s: Ventricular tachycardia
- Caveat: VT can have slower rates if patient is on an antiarrhythmic (e.g., oral flecainide or amiodarone)
- Other mimics of VT (rate often <120)
- Hyperkalemia
- Sodium channel blocker toxicity