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!
References
- 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
2 comments on “What’s the rhythm?”
From Brugada criteria RS over 100ms in any of the precordial leads is diagnostic of VT. Also Rsr pattern in V1 or BE in the setting of RBBB
Agree with these thoughts. Lots of ways to figure out ventricular versus supraventricular. I like the Rsr’ as well, sometimes called the “evil bunny” because it had a different morphology than the usual bunny ears