Slide 1: What’s the rhythm? [EKG] Hint: find the P-waves!
Slide 2: What’s the rhythm? Accelerated IdioVentricular Rhythm (AIVR) AKA “Slow VT”
Slide 3: How can you tell? Absent p-waves + widened QRS -> Ventricular Rhythm [EKG showing ventricular rate ~4 boxes = 75 BPM]
Slide 4: How can you tell? 1. Identify ventricular ectopy (absent P-waves + widened QRS). 2. Discern the beats per minute. <40 = "Ventricular escape." 40-100 = "AIVR." >100 = “Ventricular tachycardia.”
Slide 5: Why might AIVR happen? MI -> Thrombolysis -> Reperfusion -> Increased automaticity of ventricular pacemakers -> Ventricular pace > SA nodal pace. Bottom line: AIVR is commonly seen (thought less frequently so in today’s PCI era) post thrombolysis – and may be a sign that your lytics are working!
- Khan A, Nadeem S, Kokane H, et al. Is accelerated idioventricular rhythm a good marker for reperfusion after streptokinase? Indian Heart J. 2016 May-Jun;68(3):302-5. Epub 2016 Jan 12. PMID 27316481
Tags: aivr, cardiology, electrophysiology, ventricular rhythm