Accelerated Idioventricular Rhythm in Patients Without Acute Myocardial Infarction

Abstract

Accelerated idioventricular rhythm (AIVR) has been reported in patients with acute myocardial infarction, digitalis excess, and subarachnoid hemorrhage, and in pa tients with rheumatic, primary myocardial, and hypertensive heart disease. Discovery of AIVR in 2 patients without heart disease led us to review reports from 700 Holter monitor studies.

Seven patients without recent myocardial infarction were studied retrospectively. Three of the 7 had no evidence of heart dis ease ; 5 of the 7 had abnormalities of the cen tral nervous system. Examples of AIVR show approximation of the sinus rate and ectopic rate; onset and offset occur abruptly or with sinus rate slowing and fusion beats. One patient remained in AIVR for up to 10 minutes accompanied by retrograde atrial capture. The rhythm's acceleration with ex ercise suggests that it is under autonomic in fluence, a phenomenon also seen in CNS stimulation studies in dogs.

AIVR occurs infrequently in patients without demonstrable heart disease. Our ex perience suggests a good prognosis, but fur ther study is needed on the natural history of AIVR in asymptomatic patients and on the necessity of treatment.

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