Accelerated idioventricular rhythm in the adult: an update

Abstract

Introduction: accelerated idioventricular rhythm (AIVR) is a typically regular ventricular rhythm with a heart rate between 50 and 110 (-120) beats per minute, absence of P waves or sinus P waves with atrioventricular dissociation, and a wide QRS interval. It is most commonly observed in the setting of acute myocardial infarction, reperfusion therapy, and structural heart diseases. Objective: This article aims to review and update the current knowledge on accelerated idioventricular rhythm (AIVR) in adults, addressing its pathophysiology, underlying mechanisms, clinical presentation, differential diagnoses, and prognostic implications. Additionally, it seeks to synthesize the latest scientific evidence on the topic, discussing advances in clinical management and potential therapeutic approaches. Methods: a comprehensive literature search was conducted using databases such as PubMed, Scopus, and Web of Science to identify recent studies on AIVR in adults. Articles discussing its mechanisms, clinical presentation, prognosis, and treatment approaches were analyzed and synthesized. Results: AIVR is generally considered a benign arrhythmia, often self-limiting and not requiring specific treatment. However, it may indicate underlying cardiac pathology and, in some cases, contribute to hemodynamic instability. The differential diagnosis includes other ventricular arrhythmias, such as ventricular tachycardia, which necessitates careful electrocardiographic analysis. Current management strategies focus on treating the underlying condition rather than the arrhythmia itself. Conclusion: AIVR in adults remains an important electrocardiographic finding, particularly in the context of acute coronary syndromes. While usually benign, recognition and appropriate differentiation from malignant arrhythmias are essential for optimal patient management. Further research is needed to clarify its prognostic implications and therapeutic considerations.