Idioventricular rhythm
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An idioventricular rhythm is a cardiac rhythm characterized by a rate of <50 beats per minute (bpm), absence of P waves and widening of the QRS complex.[1] In cases where the heart rate is between 50 and 110 bpm, it is known as accelerated idioventricular rhythm and ventricular tachycardia if the rate exceeds 120 bpm. Causes of idioventricular rhythms are varied and can include drugs or a heart defect at birth. It is typically benign and not life-threatening.[2]
Etiology
Various etiologies may contribute to the formation of an idioventricular rhythm, and include:[1]
- Heart block
- Reperfusion after myocardial infarction
- Electrolyte abnormalities
- Heart diseases present at birth
- Certain drugs (eg. digoxin, β-agonists, anaesthetics)
Pathophysiology
The physiological pacemaker of the heart is the sinoatrial node.[3] If the sinoatrial node is rendered dysfunctional, the AV node may act as the pacemaker.[4] If both of these fail, the ventricles begin to act as the dominant pacemaker in the heart.[1] The ventricles acting as their own pacemaker gives rise to an idioventricular rhythm.
Diagnosis
An ECG trace is required for diagnosis.
Treatment
As this rhythm is not life-threatening, treatment has limited value for the patient. If underlying pathologies are identified, they should be treated appropriately. In the absence of other life-threatening arrhythmias, antiarrhythmics should be avoided as they can blunt the ventricular rate leading to hemodynamic collapse.
References
- ^ a b c Gangwani, Manesh Kumar (31 January 2020). Idioventricular Rhythm. StatPearls. PMID 32119407.
- ^ Zipes, D; Camm, AJ; Borggrefe, M; Buxton, A; Chaitman, F; et al. (September 2006). "ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: A report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". EP Europace. 8 (9): 746–837. doi:10.1093/europace/eul108. PMID 16935866.
- ^ Kashou, Anthony H.; Basit, Hajira; Chhabra, Lovely (23 June 2019). "Physiology, Sinoatrial Node". Physiology, Sinoatrial Node (SA Node). StatPearls Publishing. PMID 29083608.
- ^ Guyton, Arthur C.; Hall, John E. Textbook of Medical Physiology (11 ed.). pp. 120–121.