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Accelerated idioventricular rhythm (AIVR)

Also called AIVR.

A ventricular rhythm running 40-100: wide, regular, no P waves, faster than an escape rhythm but slower than V-tach. Common after reperfusion.

A 6-second EKG rhythm strip showing Accelerated idioventricular rhythm (AIVR).
Accelerated idioventricular rhythm (AIVR), 6 seconds of strip. Each small box is 0.04 seconds and each large box is 0.20 seconds.

How to identify Accelerated idioventricular rhythm (AIVR)

Rate
40-100
Rhythm
Regular
P waves
None
PR interval
None
QRS
Wide
Clincher
A wide ventricular rhythm faster than an escape rhythm, slower than V-tach.
Common causes
Common after reperfusion.

Rhythms it gets mistaken for

Treatment by certification level

Open your level. Treat the patient, not the strip.

Paramedic

Usually no rhythm treatment.

  • Common after reperfusion. Monitor and transport.
  • Do not suppress a wide ventricular rhythm that is the patient's own perfusing rhythm.
AEMT

Pulse present and stable.

  • Oxygen only if hypoxic or short of breath, IV access, monitoring.
  • Acquire and transmit a 12-lead ECG. Interpreting it is a Paramedic skill.
  • Transport and reassess. Request a paramedic if the patient worsens.
EMT

Pulse present: assess and support.

  • Treat the patient, not the rhythm name: airway, breathing, circulation, vital signs.
  • Oxygen if the SpO2 is under 94%, the patient is short of breath, or shows signs of shock.
  • Request ALS and transport promptly. Reassess on the way.

An AED goes only on a patient who is unresponsive, not breathing and pulseless. It cannot feel a pulse, so on a patient with a pulse it can advise a shock that would do harm.

Could you pick out Accelerated idioventricular rhythm (AIVR) on a fresh strip? See how many rhythms you can identify in one minute.

Try the 60-second rhythm challenge