Inferior Infarction and AIVR
Report:
Sinus rhythm & arrhythmia 80/min
Accelerated idioventricular rhythm 80/min
Retrograde conduction
Fusion beat (third last complex)
Acute inferior infarction
Comment:
The sinus cycle lengthens over the first three beats, allowing the AIVR to take over. The AIVR complexes have a LBBB morphology, only betraying their ventricular ectopic origin in V1 where a 0.04â primary R wave and slurred S descent distinguish them from true LBBB. Until the last three (including the fusion) beats each ectopic complex has a small but sharply etched retrograde P wave in its wake; this keep sinus rhythm in abeyance.
The first beat of the resumed and now faster sinus rhythm has a slightly shorter PR interval and the complex starts with a broad primary R wave identical to those of the AIVR: it is a fusion beat. One has to look at it carefully to identify it because the S wave is so similar to that of other, âpureâ sinus beats.
A trace taken before successful reperfusion (of which AIVR may be a marker) is shown below (Fig 76a), with more ST segment displacement.
76a. The anterior T wave inversion may well be due to the current infarction, or may have pre-existed for other reasons.
77. 46 year old lady with episodes of chest pain, admitted for coronary angiography.
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