Medication
Medication Summary
Atropine 0.25-1 mg is sometimes used to accelerate underlying sinus rate to inhibit accelerated idioventricular rhythm (AIVR).
Isoproterenol, verapamil, and antiarrhythmic drugs such as lidocaine and amiodarone are rarely used for AIVR.
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Anticholinergics
Class Summary
The goal is to accelerate sinus rate or to improve AV conduction in atrial fibrillation to inhibit AIVR.
Atropine IV/IM (Atropisol)
Used to increase heart rate through vagolytic effects, causing an increase in cardiac output (secondary, and generally not a factor in suppressing the AIVR).
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Media Gallery
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Accelerated Idioventricular Rhythm. AIVR and sinus rhythm: AIVR starts and terminates gradually, competing with sinus rhythm. A possible ventricular fusion beat (arrow) and isoarrhythmic AV dissociation (arrowheads: sinus P waves) are present. During AIVR, ectopic ventricular rate is just faster than sinus rate. AIVR has a wide QRS morphology different from the QRS morphology in sinus rhythm.
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Accelerated Idioventricular Rhythm. AIVR in atrial fibrillation: AIVR starts and terminates gradually, competing with the ventricular capture beats (arrow) from atrial fibrillation. Ventricular fusion beat (arrowhead) is present. AIVR has a wide QRS morphology different from the QRS morphology of ventricular capture beats.
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Accelerated Idioventricular Rhythm. Complete heart block with escaped junctional rhythm: The AV dissociation in complete heart block is not isoarrhythmic AV dissociation, because the atrial rate is much faster than the escaped junctional ventricular rate.
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