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Accelerated Idioventricular Rhythm
Diagnostic criteria
Since impulses originate from ventricles, QRS complexes are wide (>120ms).
Since impulses originate from 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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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 .
Click here for a more detailed ECG
Since impulses originate from ventricles, QRS complexes are wide (>120ms).
Since impulses originate from 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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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.
Click here for a more detailed ECG
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 .
Click here for a more detailed ECG