Accelerated Idioventricular Rhythm Clinical Presentation

Updated: Aug 22, 2022
  • Author: Nayereh G Pezeshkian, MD; Chief Editor: Jeffrey N Rottman, MD  more...
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History is helpful for identifying the underlying etiology for accelerated idioventricular rhythm (AIVR). The AIVR per se is often detected as an asymptomatic finding on review of ECG monitoring. The presence of the following conditions supports a potential diagnosis of AIVR:

  • Most patients with AIVR have chest pain or shortness of breath, symptoms related to myocardial ischemia. They often have recent history of myocardial reperfusion with drugs or coronary artery interventions. [26]

  • Some patients with AIVR have chest discomfort, shortness of breath, peripheral edema, cyanosis, clubbing, symptoms related to cardiomyopathy, myocarditis, and congenital heart diseases.

  • Occasionally, patients with AIVR have a history of using digoxin, some anesthetic agents, or illicit drugs such as cocaine.

  • Rarely, AIVR can occur in people without apparent heart disease and no identifiable triggers.


Physical Examination

There are no specific physical findings for accelerated idioventricular rhythm (AIVR). The following physical signs may be present:

  • Slow (< 55 bpm) or fast (>100 bpm) pulse rate.

  • Variable heart sound intensity and cannon A waves related to atrioventricular dissociation.

  • Some irregularity of heart rate/pulse rate due to competing sinus rhythm and AIVR.

  • Rarely, hypotension related to either AV asynchrony or relatively rapid ventricular heart rate during AIVR.