Diagnostic criteria

  Since the impulses arise from the ventricles, QRS complexes are wide (>120ms).

  Since the impulses arise from the ventricles, there are
no P waves preceding the QRS complexes.

  Heart rate is
40-100/minute.

  Usually observed as an arrhythmia indicating coronary
reperfusion.



Clinical significance

  Does not need to be treated.





ECG 1. The accelerated idioventricular rhythm (
blue arrows) observed immediately after successful stenting of LAD artery
in a patient with acute anterior myocardial infarction.

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ECG 2. The ECG above shows
accelerated idioventricular rhythm. To the right of the ECG, P waves start to appear . However, there is
no relationship between
the P waves and the wide QRS complexes of the accelerated idioventricular rhythm. The last 2 beats are
narrow QRS complexes
and show the restoration of sinus rhythm again.

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ECG 3. The Holter tracing above is from a 16 years old adolescent. The tracing starts as
ectopic atrial rhythm which is followed by
accelerated idioventricular rhythm
. There are no P waves preceding the wide QRS complexes of accelerated idioventricular rhythm .
The positive (upright) P wave on the right side
marks the onset of sinus rhythm.

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ECG 4. The ECG above was recorded at the 45th minute of thrombolytic infusion for the treatment of acute lateral myocardial
infarction.
The normally conducted P waves and narrow QRS complexes are interspersed between the wide QRS complexes of
accelerated idioventricular rhythm
. No P waves preceed the wide QRS complexes of accelerated idioventricular rhythm.
Leads I and aVL show ST segment elevation.

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ECG 5. The ECG above was recorded at the 26th minute of thrombolytic (tpA) infusion for the treatment of acute myocardial infarction.
The wide QRS complexes are not preceded by P waves: accelerated idioventricular rhythm.

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ECG 6. The ECG above shows
accelerated idioventricular rhythm . Only at lead aVR, the QRS complexes seem as if they are narrow .
However, the simultaneous recording of the leads aVL and aVF show that they are wide QRS complexes.
The P waves in lead aVR
are not related to
the QRS complexes in front of them . The clue for this is that the PR interval is progressively shortening .

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