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BMC Cardiovascular Disorders Sep 2021Accelerated idioventricular rhythm (AIVR) is often transient, considered benign and requires no treatment. This observational study aims to investigate the clinical... (Observational Study)
Observational Study
BACKGROUND
Accelerated idioventricular rhythm (AIVR) is often transient, considered benign and requires no treatment. This observational study aims to investigate the clinical manifestations, treatment, and prognosis of frequent AIVR.
METHODS
Twenty-seven patients (20 male; mean age 32.2 ± 17.0 years) diagnosed with frequent AIVR were enrolled in our study. Inclusion criteria were as follows: (1) at least three recordings of AIVR on 24-h Holter monitoring with an interval of over one month between each recording; and (2) resting ectopic ventricular rate between 50 to 110 bpm on ECG. Electrophysiological study (EPS) and catheter ablation were performed in patients with distinct indications.
RESULTS
All 27 patients experienced palpitation or chest discomfort, and two had syncope or presyncope on exertion. Impaired left ventricular ejection fraction (LVEF) was identified in 5 patients, and LVEF was negatively correlated with AIVR burden (P < 0.001). AIVR burden of over 73.8%/day could predict impaired LVEF with a sensitivity of 100% and specificity of 94.1%. Seventeen patients received EPS and ablation, five of whom had decreased LVEF. During a median follow-up of 60 (32, 84) months, LVEF of patients with impaired LV function returned to normal levels 6 months post-discharge, except one with dilated cardiomyopathy (DCM). Two patients died during follow-up. The DCM patient died due to late stage of heart failure, and another patient who refused ablation died of AIVR over-acceleration under fever.
CONCLUSIONS
Frequent AIVR has unique clinical manifestations. 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.
Topics: Accelerated Idioventricular Rhythm; Action Potentials; Adolescent; Adult; Catheter Ablation; Clinical Decision-Making; Female; Heart Conduction System; Heart Rate; Humans; Male; Middle Aged; Prospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult
PubMed: 34496747
DOI: 10.1186/s12872-021-02221-0 -
Archivos de Cardiologia de Mexico 2021The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the... (Review)
Review
OBJECTIVE
The objective of this study was to describe the case of a 19-year-old male presenting with bradycardia and hypotension after a honeybee sting making a review of the literature and pathophysiology of the cardiovascular and electrocardiogram (EKG) changes after a bee sting.
METHODS
The patient's airway was inspected and secured. Electrocardiogram with an idioventricular rhythm at 41' bpm. Oxygen was administered, an intravenous access was established, and the transcutaneous pacemaker leads were placed on the chest of the patient, then published guidelines management was induced.
RESULTS
The EKG showed idioventricular rhythm at a rate of 41 beats/min that resolved to a normal sinus rhythm after treatment.
CONCLUSIONS
A full and prompt cardiovascular evaluation should be performed in all patients presenting to the emergency department after a bee sting, and published guidelines regarding the management of bradycardia and anaphylaxis should be followed to achieve successful outcomes.
Topics: Animals; Arrhythmias, Cardiac; Bees; Bradycardia; Electrocardiography; Heart Rate; Humans; Insect Bites and Stings; Male; Pacemaker, Artificial; Shock
PubMed: 33887752
DOI: 10.24875/ACM.20000035 -
Proceedings (Baylor University. Medical... Oct 2018
PubMed: 31080367
DOI: 10.1080/08998280.2018.1493323 -
Ultrasound in Obstetrics & Gynecology :... Nov 2017As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is...
OBJECTIVES
As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia.
METHODS
We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014.
RESULTS
Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in central venous pressure in all and hydrops fetalis in two cases without evidence of ventricular dysfunction.
CONCLUSIONS
Echocardiographic criteria required for postnatal diagnosis of AIVR can be documented in utero using specific ultrasonographic approaches. During fetal life, AIVR may not be a benign entity. Hydrops fetalis is frequently associated with AIVR because of increase in central venous pressure related to simultaneous atrioventricular contractions; thus, the ultrasonographic investigation protocol of fetuses with unexplained hydrops fetalis should aim at ruling out AIVR and include Doppler flow recordings in SVC/Ao, DV, AoI, DA and umbilical vein. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Accelerated Idioventricular Rhythm; Aorta; Bundle-Branch Block; Ductus Arteriosus; Echocardiography, Doppler; Female; Fetal Diseases; Humans; Hydrops Fetalis; Pregnancy; Prognosis; Retrospective Studies; Ultrasonography, Prenatal; Vena Cava, Superior
PubMed: 27943499
DOI: 10.1002/uog.17382 -
Anesthesia Progress Dec 2022Accelerated idioventricular rhythm has been documented in several cases involving the induction of general anesthesia; however, it has not previously been known to occur...
Accelerated idioventricular rhythm has been documented in several cases involving the induction of general anesthesia; however, it has not previously been known to occur during reversal of neuromuscular blockade with neostigmine and glycopyrrolate. The current understanding of the pathophysiology of accelerated idioventricular rhythm involves enhanced automaticity of ventricular myocardium in the setting of increased vagal tone suppressing sinoatrial node pace making. We present the case of an 8-year-old boy who developed accelerated idioventricular rhythm during dental rehabilitation. In this case, accelerated idioventricular rhythm developed immediately upon reversal of neuromuscular blockade with neostigmine and glycopyrrolate and recurred intermittently during his recovery in the postanesthesia care unit. This was a benign occurrence in our patient who remained asymptomatic and hemodynamically stable, and his arrhythmia eventually subsided without intervention after several hours of telemetry. This case suggests that reversal of neuromuscular blockade with neostigmine and glycopyrrolate may induce accelerated idioventricular rhythm in certain patients without known cardiovascular disease.
Topics: Male; Humans; Child; Glycopyrrolate; Neostigmine; Accelerated Idioventricular Rhythm
PubMed: 36534779
DOI: 10.2344/anpr-69-02-13 -
JACC. Case Reports Dec 2022An accelerated idioventricular rhythm was seen on a routine preparticipation electrocardiogram of a 19-year-old healthy and symptom-free athlete. Family history was...
An accelerated idioventricular rhythm was seen on a routine preparticipation electrocardiogram of a 19-year-old healthy and symptom-free athlete. Family history was negative for cardiac disease. Additional investigations revealed a hypertrophic cardiomyopathy, confirmed with cardiac magnetic resonance imaging and genetic analysis. Accelerated idioventricular rhythm in young athletes warrants careful clinical evaluation. ().
PubMed: 36507292
DOI: 10.1016/j.jaccas.2022.09.023 -
EuroIntervention : Journal of EuroPCR... Aug 2011
Topics: Accelerated Idioventricular Rhythm; Ambulances; Angioplasty, Balloon, Coronary; Coronary Occlusion; Delivery of Health Care, Integrated; Electrocardiography; Emergency Medical Services; Female; Fibrinolytic Agents; Gene Expression Profiling; Health Services Accessibility; Hemodynamics; Humans; Male; Myocardial Infarction; Outcome and Process Assessment, Health Care; Platelet Aggregation Inhibitors; RNA, Messenger; Telemetry; Tirofiban; Transcription, Genetic; Tyrosine
PubMed: 21764657
DOI: 10.4244/EIJV7I4A68