What causes AIVR?
Causes of Accelerated Idioventricular Rhythm (AIVR) Beta-sympathomimetics such as isoprenaline or adrenaline. Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane. Electrolyte abnormalities. Cardiomyopathy, congenital heart disease, myocarditis.
What are the symptoms of Idioventricular rhythm?
History
- Most patients with AIVR have chest pain or shortness of breath, symptoms related to myocardial ischemia.
- Some patients with AIVR have chest discomfort, shortness of breath, peripheral edema, cyanosis, clubbing, symptoms related to cardiomyopathy, myocarditis, and congenital heart diseases.
Is AIVR benign?
AIVR is usually a benign and well-tolerated arrhythmia. Most of the cases will require no treatment and in rare situations such as sustained or incessant AIVR or when AV dissociation induces syncope, the risk of sudden death is higher, and the arrhythmia should be treated.
Is AIVR regular?
Electrocardiogram characteristics of AIVR include a regular rhythm, 3 or more ventricular complexes with QRS complex > 120 milliseconds, a ventricular rate between 50 beats/min and 110 beats/min, and occasional fusion or capture beats.
How is AIVR treated?
Under these situations, atropine can be used to increase the underlying sinus rate to inhibit AIVR. Other treatments for AIVR, which include isoproterenol, verapamil, antiarrhythmic drugs such as lidocaine and amiodarone, and atrial overdriving pacing are only occasionally used today.
What is an AIVR?
AIVR is currently defined as an enhanced ectopic ventricular rhythm with at least 3 consecutive ventricular beats, which is faster than normal intrinsic ventricular escape rhythm (≤40 bpm), but slower than ventricular tachycardia (at least 100-120 bpm).
Can you have AIVR with AFIB?
AIVR can occur in atrial fibrillation (see image below) and other rhythms when the rate of firing in ectopic ventricular focus surpasses that of the underlying dominant ventricular rate.
When do you treat AIVR?
Patients with AIVR should be treated mainly for its underlying causes, such as digoxin toxicity, myocardial ischemia, and structure heart diseases. Beta-blockers are often used in patients with myocardial ischemia-reperfusion and cardiomyopathy. Transfer to advanced care facility depends on associated conditions.
Is AIVR a lethal rhythm?
Lethal arrhythmias: –Sustained ventricular tachycardia. –Ventricular fibrillation. –Accelerated idioventricular rhythm (AIVR).
Is Idioventricular rhythm life threatening?
Causes of idioventricular rhythms are varied and can include drugs or a heart defect at birth. It is typically benign and not life-threatening.
What rate is AIVR?
The ventricular rate of AIVR is generally between 40 to 100-120 bpm. Usually, AIVR is hemodynamically well tolerated due to its slow ventricular rate. It is self-limited and resolves as sinus rate surpasses the rate of AIVR. Rarely, AIVR can degenerate into ventricular tachycardia or ventricular fibrillation.
Can AIVR be irregular?
Monophasic R-wave with smooth upstroke and notching on the downstroke (i.e., the so-called taller left peak or “rabbit-ear”.) It can be present at birth. However, it is more commonly associated with reperfusion after myocardial injury. AIVR is generally considered to be a benign abnormal heart rhythm.
Is there an additional benefit of reperfusion in relation to edema?
This study identifies an additional benefit of reperfusion in relation to edema, as well as rescuing ischemic brain tissue at risk for infarction. Trial Registration Netherlands Trial Registry number: NTR1804and Current Controlled Trials number: ISRCTN10888758 Introduction
What is AIVR and how is it treated?
Management AIVR is a benign rhythm in most settings and does not usually require treatment Usually self limiting and resolves when sinus rate exceeds that of the ventricular foci Administration of anti-arrhythmics may cause precipitous haemodynamic deterioration and should be avoided
Is brain edema associated with delayed reperfusion and lower aspects?
A secondary hypothesis was that in patients with delayed reperfusion or lower ASPECTS, brain edema could partially be responsible for the worse functional outcome. Methods Patient Characteristics
What is AIVR rhythm in acute STEMI?
Classically seen in the reperfusion phase of an acute STEMI (e.g. post-thrombolysis) Note: ventricular rate of AIVR distinguishes it from others rhythms of similar morphology (e.g. <50 BPM = ventricular escape rhythm; >110 BP = ventricular tachycardia)