1. The underlying disease should be treated.

2. Antiarrhythmics are indicated in patients with symptomatic episodes or beats that initiate ventricular tachycardia.

ACCELERATED IDIOVENTRICULAR RHYTHM (AIVR) AIVR is an ectopic rhythm of ventricular origin occurring at a rate of 40 to 100. Even though AIVR is not a tachycardia, such terms as idioventricular tachycardia, nonparoxysmal ventricular tachycardia, or slow ventricular tachycardia are sometimes used to describe this rhythm.

The ECG characteristics of AIVR are (1) wide and regular QRS complexes, (2) a rate between 40 and 100 that is often close to the preceding sinus rate, (3) most runs of short duration (3 to 30 beats), and (4) an AIVR often beginning with a fusion beat ( Fig. 24-18).

FIG. 24-18. Accelerated idioventricular rhythms (AIVR).

Clinical Significance This condition is found most commonly in the setting of an acute MI. Reports indicate that AIVR sometimes appears during successful thrombolysis of an occluded coronary artery. AIVR and other ventricular dysrhythmias seen during this time are termed reperfusion dysrhythmias. AIVR may be seen infrequently in patients without organic heart disease. While there is some variable association with ventricular tachycardia, there is no apparent association with ventricular fibrillation. AIVR usually produces no symptoms itself. Sometimes the loss of atrial contraction and subsequent fall in cardiac output may produce hemodynamic deterioration.

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