From the Research
Accelerated idioventricular rhythm (AIVR) is a cardiac arrhythmia that is usually benign and transient, requiring no specific treatment if the patient is hemodynamically stable, as evident from the most recent study in 2023 1. The diagnosis of AIVR is based on the presence of an ectopic ventricular rhythm with a rate of 50-110 beats per minute, which is faster than normal ventricular escape rhythm but slower than ventricular tachycardia. AIVR typically occurs when the sinus node slows down or fails, allowing a ventricular focus to take over as the heart's pacemaker. This rhythm is commonly seen during reperfusion after myocardial infarction, in digitalis toxicity, cardiomyopathies, or electrolyte disturbances.
Key Characteristics of AIVR
- Ectopic ventricular rhythm with a rate of 50-110 beats per minute
- Faster than normal ventricular escape rhythm but slower than ventricular tachycardia
- Usually benign and transient
- Requires no specific treatment if the patient is hemodynamically stable
Treatment of AIVR
- If the patient is hemodynamically stable, no specific treatment is required 1
- If the patient becomes symptomatic with hypotension or decreased cardiac output, atropine can be administered to increase the sinus rate and suppress the ventricular focus
- The typical dose of atropine is 0.5-1 mg IV, which can be repeated every 3-5 minutes up to a maximum of 3 mg
- In cases where AIVR is caused by digitalis toxicity, discontinuation of the medication is necessary
- For persistent symptomatic AIVR, temporary pacing may be considered to override the ventricular rhythm
Importance of Underlying Cause
- Continuous cardiac monitoring is essential during management
- Addressing the underlying cause is crucial for long-term resolution of the arrhythmia
- Preventing the causes of arrhythmias, including hypothermia, is the best strategy, as highlighted in the 2023 study 1