Accelerated Idioventricular Rhythm Treatment & Management

Updated: Dec 21, 2016
  • Author: Nayereh G Pezeshkian, MD; Chief Editor: Jeffrey N Rottman, MD  more...
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Treatment

Medical Care

Treatment for accelerated idioventricular rhythm (AIVR) does not change the prognosis. The most important therapy for patients with AIVR is to treat the underlying etiology.

AIVR is usually hemodynamically tolerated and self-limited; thus, it rarely requires treatment.

Occasionally, patients may not tolerate AIVR due to (1) loss of atrial-ventricular synchrony, (2) relative rapid ventricular rate, or (3) ventricular tachycardia or ventricular fibrillation degenerated from AIVR (extremely rare). Under these situations, atropine can be used to increase the underlying sinus rate to inhibit AIVR.

Other treatments for AIVR, which include isoproterenol, verapamil, antiarrhythmic drugs such as lidocaine and amiodarone, and atrial overdriving pacing are only occasionally used today.

Patients with AIVR should be treated mainly for its underlying causes, such as digoxin toxicity, myocardial ischemia, and structure heart diseases. Beta-blockers are often used in patients with myocardial ischemia-reperfusion and cardiomyopathy. Transfer to advanced care facility depends on associated conditions.

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Consultations

A cardiology or electrophysiology consult may be helpful in difficult cases.

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Diet

No particular diet is helpful.

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Activity

Activity may increase sinus rate and inhibit AIVR in some patients. In others, activity may not be well tolerated during AIVR; therefore, temporary bed rest or atropine therapy is reasonable.

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Prevention

Prevention is usually unnecessary due to the benign nature of most AIVR events. Occasionally for patients with significant symptoms and hemodynamic instability, atropine can be used to reduce AIVR recurrence by increasing sinus rate.

Avoiding drugs that cause AIVR is helpful.

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Long-Term Monitoring

The underlying causes for AIVR should be treated accordingly.

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