Accelerated idioventricular rhythm: Difference between revisions
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==Background== | ==Background== | ||
*Results when rate of an ectopic ventricular pacemaker exceeds sinus node | *Results when rate of an ectopic ventricular pacemaker exceeds sinus node | ||
*Usually benign,self limiting | *Usually benign,self limiting | ||
===Causes=== | ===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== | ==Clinical Features== | ||
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==Diagnosis== | ==Diagnosis== | ||
===ECG features=== | ===[[ECG]] features=== | ||
*Regular rhythm | |||
*Rate 50-110 bpm | |||
*Three or more ventricular complexes | |||
*QRS complexes >120ms | |||
*Fusion and capture beats | |||
==Management== | ==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 | |||
*Anti-arrhythmics 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== | ==Disposition== | ||
*Normally outpatient | |||
==See Also== | ==See Also== | ||
Revision as of 04:04, 9 June 2016
Background
- Results when rate of an ectopic ventricular pacemaker exceeds sinus node
- Usually benign,self limiting
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
Differential Diagnosis
Diagnosis
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
- Anti-arrhythmics 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