AIVR: AV Dissociation
Report:
Sinus tachycardia 100 - 110/min
Accelerated idioventricular rhythm (AIVR) 98/min
AV dissociation
Fusion beats
Comment:
Like digoxin, hypokalæmia enhances subsidiary pacemaker automaticity. Even if the AIVR persisted after correction of hypokalæmia, however, it would not merit specific therapy.
The 4-beat run in the middle of the middle strip consists of fusion complexes only.
Below is a similar trace (Fig 159a), from a 15 year old recovering from ARDS due to massive bleed from Meckelâ s diverticulum. His AIVR shows only one fusion beat and little AV dissociation: most of it has retrograde conduction.
159a. The AIVR starts with a fusion beat and the next one has a half-buried P wave at its onset; retrograde conduction sets in from then on. Its extinction in the last two AIVR beats (bottom strip) allows P waves to re-emerge and capture the ventricles. There is no fusion in the last AIVR beat: the PR interval is too short. 160. 70 year old man with chronic ischæmic heart disease and controlled heart failure. The monitor showed bradycardia 54/min.
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