Accelerated idioventricular rhythm: Difference between revisions
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Revision as of 22:04, 21 July 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
- Asymptomatic or palpitations
Differential Diagnosis
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
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