Accelerated idioventricular rhythm differential diagnosis
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Accelerated idioventricular rhythm Microchapters |
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Differentiating Accelerated idioventricular rhythm from other Diseases |
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Diagnosis |
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Treatment |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Differentiating Accelerated idioventricular rhythm from other Diseases
- Because of its slower rate it may resemble normal sinus rhythm (NSR). Look for numerous fusion beats. The term accelerated isorhythmic ventricular rhythm has been suggested.
- Must be distinguished from junctional tachycardia with preexisting IVCDs. But in these patients there are no fusion or capture beats.
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).[1] Importantly, there is rate overlap between AIVR and some slow ventricular tachycardia. AIVR should not be diagnosed solely based on ventricular rate. Other characteristics of AIVR are helpful for its correct diagnosis (see Differentials).
AIVR is generally a transient rhythm, rarely causing hemodynamic instability and rarely requiring treatment. However, misdiagnosis of AIVR as slow ventricular tachycardia or complete heart block can lead to inappropriate therapies with potential complications. AIVR is often a clue to certain underlying conditions, like myocardial ischemia-reperfusion, digoxin toxicity, and cardiomyopathies.[2, 3, 4]