Accelerated Idioventricular Rhythm Treatment & Management

Updated: Aug 22, 2022
  • Author: Nayereh G Pezeshkian, MD; Chief Editor: Jeffrey N Rottman, MD  more...
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Approach Considerations

Patients with accelerated idioventricular rhythm (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. 


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


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.


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.


Transfer to an advanced care facility depends on associated conditions.



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 direct treatment. In fact, the recognition of AIVR and the associated etiology is often critical in avoiding treatment for a confounding diagnosis (such as ventricular tachycardia).

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 rarely used today.