AIVR
Report:
Accelerated idioventricular rhythm 84/min
Marked respiratory swing
Comment:
The 0.16” qRR’ complexes in V1 are the best evidence for the ventricular ectopic origin of the rhythm; lack of septal q in lead 1 and rS in V6 also lend some support. The marked axis deviation, in this case, does not: this could be a LAHB with R in lead 1 diminished by infarction (the same LAHB would then be responsible for q in V1-2 or rS in V6). There is no atrial activity, although some would be misled by U waves in V5-6. Finally, the rate is too slow to cause aberrancy; if this were junctional rhythm with RBBB + LAHB, the patient would have the same conduction in sinus rhythm. This is clearly not the case (Fig 135a).
The rabbit ears in V1 are only helpful when the left one is bigger; the bigger right one, as here, is diagnostically a 50:50 proposition.
AIVR is commonly seen in the setting of inferior ischæmia or infarction and during digoxin therapy.
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