Accelerated Idioventricular Rhythm

A type of automatic, not reentrant, ectopic ventricular rhythm with episodes lasting from a few seconds to a minute which usually occurs in patients with acute myocardial infarction or with DIGITALIS toxicity. The ventricular rate is faster than normal but slower than tachycardia, with an upper limit of 100 -120 beats per minute. Suppressive therapy is rarely necessary.

Also Known As:

Networked: 110 relevant articles (2 outcomes, 6 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Accelerated Idioventricular Rhythm
2.	Heart Block
3.	MINOCA
4.	Ventricular Tachycardia
5.	Ventricular Fibrillation

Experts

1.	Shoda, Morio: 2 articles (09/2021 - 02/2014)
2.	Klein, Gunnar: 2 articles (06/2013 - 11/2005)
3.	Baan, Jan: 2 articles (08/2011 - 12/2010)
4.	Delewi, Ronak: 2 articles (08/2011 - 12/2010)
5.	Piek, Jan J: 2 articles (08/2011 - 12/2010)
6.	Remmelink, Maurice: 2 articles (08/2011 - 12/2010)
7.	Mewis, Christian: 2 articles (07/2006 - 11/2002)
8.	Aliot, Etienne: 2 articles (08/2005 - 12/2003)
9.	Mletzko, Ralph: 2 articles (08/2005 - 12/2003)
10.	Sadoul, Nicolas: 2 articles (08/2005 - 12/2003)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Accelerated Idioventricular Rhythm:

1.	Sotalol (Sotalol Hydrochloride)FDA LinkGeneric 11/01/1992 - "Prolongation of QRS duration or late potential duration may reflect a slowing of conduction by sotalol that may interfere with this agent's antiarrhythmic efficacy and slow ventricular tachycardia." 02/01/2020 - "IV sotalol in the setting of ECMO and CRRT was safe and effective in controlling refractory hemodynamically compromising accelerated idioventricular rhythm unresponsive to amiodarone."
2.	Amiodarone (Amiodarona)FDA LinkGeneric 11/26/1993 - "Class 1 effects are responsible for amiodarone's ability to slow ventricular tachycardias, making them hemodynamically better tolerated, and are likely important in amiodarone's premature ventricular complex-suppressing properties. " 02/01/2020 - "IV sotalol in the setting of ECMO and CRRT was safe and effective in controlling refractory hemodynamically compromising accelerated idioventricular rhythm unresponsive to amiodarone." 02/01/2020 - "Post-operatively, the patient developed hemodynamically significant accelerated idioventricular rhythm which was not responsive to a combination of amiodarone, lidocaine, and procainamide leading to 2 cardiac arrest events and placement on ECMO. "
3.	TroponinIBA 01/01/2021 - "This study reports the case of a 23-year-old single woman referring to the hospital with clinical manifestations of MI, with electrocardiography findings of slow ventricular tachycardia or accelerated idioventricular rhythm and atrioventricular dissociation, and high troponin levels, which was admitted with the diagnosis of MINOCA due to mental stress (grief) and was discharged after 4 days of monitoring and following stabilization of conditions and absence of symptoms. "
4.	Desflurane (I 653)FDA Link 05/01/2009 - "We report here on a case of AIVR that was related to desflurane administration." 08/01/2002 - "We report a case in which rapid administration of desflurane precipitated an accelerated idioventricular rhythm in a patient. " 08/01/2002 - "Accelerated idioventricular rhythm associated with desflurane administration." 05/01/2009 - "Accelerated idioventricular rhythm associated with desflurane anesthesia :A case report." 01/01/2015 - "Accelerated idioventricular rhythm (AIVR) during anesthesia has been described in several drug toxicity such as from cocaine, halothane, desflurane, and propofol. "
5.	Propofol (Diprivan)FDA LinkGeneric 07/01/2010 - "Accelerated idioventricular rhythm following propofol induction in a dog undergoing ocular surgery." 01/01/2015 - "This case suggests that the suppression of sinus and atrioventricular nodal function and the autonomic imbalance caused by propofol and remifentanil may induce AIVR with greater frequency." 01/01/2015 - "We present the case of a man who developed episodes of AIVR observed under total intravenous anesthesia (TIVA) using remifentanil, propofol, and rocuronium. " 01/01/2015 - "Accelerated idioventricular rhythm observed under total intravenous anesthesia using remifentanil, propofol, and rocuronium." 01/01/2015 - "Accelerated idioventricular rhythm (AIVR) during anesthesia has been described in several drug toxicity such as from cocaine, halothane, desflurane, and propofol. "
6.	Verapamil (Calan)FDA LinkGeneric 07/01/1983 - "Verapamil caused no change in the rate of AIVR in 1 patient, but in a second patient it decreased the rate by 20 beats/min. In 4 patients, verapamil abolished the arrhythmia: in 2 patients carotid sinus pressure (induced sinus slowing) allowed the emergence of the AIVR at a lower rate, and in the remaining 2 patients the arrhythmia was not observed." 07/01/1983 - "Intravenous verapamil (3 to 5 mg bolus) was administered to 6 patients with multiform AIVR in whom the arrhythmias were persistent enough to allow the evaluation of the effect of verapamil on the arrhythmia. " 07/01/1983 - "Multiform accelerated idioventricular rhythm in acute myocardial infarction: electrocardiographic characteristics and response to verapamil." 12/01/1998 - "Slow ventricular tachycardia located in the epicardium of the left ventricular base and characterized by effects of adenosine triphosphate, nicorandil and verapamil."
7.	StreptokinaseFDA Link 05/01/2016 - "Is accelerated idioventricular rhythm a good marker for reperfusion after streptokinase?" 11/01/1986 - "The incidence of accelerated idioventricular rhythm and ventricular tachycardia was evaluated in 52 consecutive patients undergoing thrombolysis with intracoronary streptokinase during acute myocardial infarction. "
8.	SolutionsIBA 06/01/2004 - "Accelerated idioventricular rhythm associated to ophthalmic timolol/dorzolamide solution." 09/01/1992 - "A case of slow ventricular tachycardia occurring in a 65-year-old man with a dilated cardiomyopathy following an accidental overdose of naftidrofuryl (2 x 200 mg ampules in 250 ml of 5% glucose solution in 2 hours) prescribed for complicated arterial disease of the lower limbs is reported. "
9.	Mexiletine (Mexitil)FDA LinkGeneric 08/01/1984 - "The number of all VPBs (P less than 0.05), hours with occurrence of AIVR (P less than 0.05), runs (P less than 0.01) and Ron T beats (P less than 0.05) was smaller in the mexiletine than in the placebo group. " 08/01/1984 - "The number of patients who had any event of accelerated idioventricular rhythm (AIVR; P less than 0.05) runs of ventricular premature beats (VPBs; P less than 0.01), ventricular tachycardia (P less than 0.01) and Ron T beats (P less than 0.05) was smaller in the mexiletine group than in the placebo group. " 06/01/1993 - "Combination treatment with aprindine (0.1 mg/kg/min for 10 min) and mexiletine (0.3 mg/kg/min for 5 min) enhanced antiarrhythmic effects of a single treatment of aprindine (0.1 mg/kg/min for 10 min) on digitalis and 24-h two-stage coronary ligation-induced arrhythmia models, but in the 48-h two-stage coronary ligation-induced arrhythmia model, a slow ventricular tachycardia (VT) model, addition of mexiletine to aprindine caused no enhancement of antiarrhythmic effects. "
10.	Lidocaine (Xylocaine)FDA LinkGeneric 03/01/1986 - "Seven of the 13 patients receiving lidocaine had ventricular tachycardia or accelerated idioventricular rhythm, compared with 2 of 16 receiving tocainide (p less than 0.05). " 02/01/2020 - "Post-operatively, the patient developed hemodynamically significant accelerated idioventricular rhythm which was not responsive to a combination of amiodarone, lidocaine, and procainamide leading to 2 cardiac arrest events and placement on ECMO. "

Therapies and Procedures

1.	Implantable Defibrillators (Implantable Cardioverter-Defibrillator) 12/01/2003 - "Safety and efficacy of a dual chamber implantable cardioverter defibrillator capable of slow ventricular tachycardia discrimination: a randomized study." 08/16/2005 - "This study aims to assess the incidence and clinical relevance of slow ventricular tachycardia (VT) and the effectiveness and/or deleterious effects of antitachycardia pacing in slow VT in implantable cardioverter-defibrillator recipients. " 08/31/2004 - "The 1+1 trial: a prospective trial of a dual- versus a single-chamber implantable defibrillator in patients with slow ventricular tachycardias." 04/01/2023 - "Appropriate inappropriate shocks: Inappropriate oversensing during slow ventricular tachycardia in a patient with a subcutaneous implantable cardioverter-defibrillator." 08/01/2017 - "Slow ventricular tachycardia (VT) in patients with devices such as an implantable cardioverter - defibrillator (ICD) is more common than in the rest of the population. "
2.	Therapeutics 11/01/2007 - "Low left ventricular ejection fraction (LVEF), positive EP study, and 'slow' ventricular tachycardia predicted appropriate therapy. " 03/01/2022 - "We present the case of a healthy newborn diagnosed with an accelerated idioventricular rhythm which is spontaneously terminated without the need for medical therapy." 09/01/2010 - "DC ICD therapy optimization is achieved by optimal customizing of antitachycardia therapy parameters, activation of discrimination algorithms, antitachycardia pacing in the slow ventricular tachycardia zone, and avoidance of right ventricular pacing with the SafeR algorithm mode. " 11/01/2005 - "It appears that patients with slow ventricular tachycardias, being at high risk for inappropriate ICD therapy, might benefit from dual-chamber ICD therapy. " 04/01/2003 - "This therapy is appropriate even if the frequency of the accelerated idioventricular rhythm is high."
3.	Catheter Ablation 03/01/2020 - "In such cases, electrophysiologic study and catheter ablation are a good option in such cases with accelerated idioventricular rhythm for an ultimate cure." 12/01/2003 - "While radio frequency (RF) catheter ablation (RCA) procedures for treating ventricular arrhythmias have evolved significantly over the past several years, the use of RCA has been limited to treating slow ventricular tachycardias (VTs). " 01/01/2012 - "Symptoms appeared 10 years after the AIVR was first noted, and she underwent catheter ablation for curative therapy of AIVR after 12 years. " 01/01/2021 - "AIVR patients with burden of over 70%, impaired LVEF, and/or symptoms of syncope or presyncope due to over-response to sympathetic tone should be considered for catheter ablation." 11/01/2017 - "Accelerated idioventricular rhythm requiring catheter ablation in a child: The dark side of a benign arrhythmia."
4.	Defibrillators (Defibrillator) 10/01/2021 - "The clinical impact of slow ventricular tachycardia (VT), occurring in patients carrying implantable cardiac defibrillators (ICD), is still under debate. " 10/01/2021 - "The clinical impact of untreated slow ventricular tachycardia in patients carrying implantable cardiac defibrillators." 11/01/2007 - "Electrophysiological study and 'slow' ventricular tachycardia predict appropriate therapy: results from a single-centre implantable cardiac defibrillator follow-up." 09/01/2021 - "Left atrial reentrant tachycardia with interatrial dissociation mimicking accelerated idioventricular rhythm in a patient with a cardiac resynchronization defibrillator." 01/01/2019 - "A 53-year-old male with heart failure secondary to anterior wall myocardial infarction treated with cardiac resynchronization-defibrillator (CRT-D) device presented with ventricular arrhythmia: repetitive incessant slow ventricular tachycardias (VT) below the CRT-D detection zone, accelerated ventricular rhythm, and numerous premature ventricular ectopic beats (ExV), resulting in loss of biventricular pacing. "
5.	Percutaneous Coronary Intervention 01/01/2019 - "He was taken to the cardiac catheterization lab for percutaneous coronary intervention (PCI) of his left anterior descending artery, whereupon he developed hemodynamically significant accelerated idioventricular rhythm necessitating intra-aortic balloon pump placement. " 08/01/2011 - "Acute haemodynamic effects of accelerated idioventricular rhythm in primary percutaneous coronary intervention." 04/01/2005 - "Accelerated idioventricular rhythm in the post-thrombolytic era: incidence, prognostic implications, and modulating mechanisms after direct percutaneous coronary intervention." 12/01/2010 - "More pronounced diastolic left ventricular dysfunction in patients with accelerated idioventricular rhythm after reperfusion by primary percutaneous coronary intervention." 12/15/2009 - "Prevalence and significance of accelerated idioventricular rhythm in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention."