Idioventricular rhythm

Etiology

Various etiologies may contribute to the formation of an idioventricular rhythm, and include:

• 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. If the sinoatrial node is rendered dysfunctional, the AV node may act as the pacemaker. If both of these fail, the ventricles begin to act as the dominant pacemaker in the heart. 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

References

1. (31 January 2020). "Idioventricular Rhythm". StatPearls.
2. (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.
3. (23 June 2019). "Physiology, Sinoatrial Node (SA Node)". StatPearls Publishing.
4. "Textbook of Medical Physiology".