Accelerated Idioventricular Rhythm

Report:

Accelerated idioventricular rhythm 96/min

AV dissociation

Fusion beat

Sinus rhythm 98/min

Anterior infarction ?age

Comment:

This has, at times, been called slow VT. There is no such thing: the term is a contradictio in adjecto. There can be no more slow tachycardia than a native Esperanto speaker!

If the rate were 100/min or more, this would qualify for the designation of VT. Here, between 100 and 130/min, there may be some legitimacy in calling it AIVR, if only to emphasise its idiofocal nature, dear to Schamroth.

The ventricular ectopic origin is proven by both the QRS morphology and the fusion (third last) beat. The patient had an obvious extensive anterior infarction (Fig 120a) and received streptokinase; this AIVR may be an example of a reperfusion arrhythmia. AIVR is the most specific arrhythmic marker of reperfusion, but lacks sensitivity. It is common in this setting.

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