II. Mechanism

  1. Benign transient Dysrhythmia (typically lasts minutes and resolves)
  2. Occurs after STEMI with coronary reperfusion (spontaneous or after PCI, Fibrinolysis)

III. Findings

  1. Regular wide complex rhythm (at least 3 consecutive beats)
  2. No P Waves (or P Waves with atrioventricular dissociation)
  3. Heart Rates typically 40 to 120 bpm

IV. Differential Diagnosis

  1. See Wide Complex Tachycardia
  2. Ventricular Tachycardia
    1. Typically presents with Heart Rates >120-130
  3. Other causes
    1. Digoxin Toxicity
    2. Electrolyte abnormalities (e.g. Hyperkalemia)
    3. Cardiac ischemia

V. Management

  1. Observation of suspected AIVR rhythm only
  2. Antidysrhythmic medications may degenerate AIVR to Asystole

VI. References

  1. Berberian and Brady (2024) Crit Dec Emerg Med 38(3): 15

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