Accelerated idioventricular rhythm: Difference between revisions
Mustafaomar (talk | contribs) (Created page with "===Background=== AIVR results when rate of an ectopic ventricular pacemaker exceeds sinus node. Usually benign,self limiting ===Causes=== #Reperfusion phase of acute myocardia...") |
Mustafaomar (talk | contribs) |
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#Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion. | #Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion. | ||
#Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction. | #Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction. | ||
=== | ===References=== | ||
http://lifeinthefastlane.com/ecg-library/aivr/ | http://lifeinthefastlane.com/ecg-library/aivr/ | ||
Revision as of 08:40, 17 May 2016
Background
AIVR results when rate of an ectopic ventricular pacemaker exceeds sinus node. Usually benign,self limiting
Causes
- Reperfusion phase of acute myocardial infarction (= most common cause)
- Beta-sympathomimetics (isoprenaline or adrenaline)
- Drug toxicity, especially digoxin, cocaine and volatile anaesthetics such as desflurane
- Electrolyte abnormalities
- Cardiomyopathy, congenital heart disease, myocarditis
- Return of spontaneous circulation (ROSC) following cardiac arrest
- Athletic heart
ECG features
- Regular rhythm.
- Rate 50-110 bpm.
- Three or more ventricular complexes.
- QRS complexes >120ms.
- Fusion and capture beats.
Management
- AIVR is a benign rhythm in most settings and does not usually require treatment.
- Self limiting and resolves when sinus rate exceeds that of the ventricular foci.
- Anti-arrhythmics may cause precipitous haemodynamic deterioration and should be avoided.
- Treat the underlying cause: e.g. correct electrolytes, restore myocardial perfusion.
- Patients with low-cardiac-output states (e.g. severe biventricular failure) may benefit from restoration of AV synchrony to restore atrial kick – in this case atropine may be trialled to increase sinus rate and AV conduction.