JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Figure 2. ECG recorded 3 weeks earlier. See text for explication.
DIAGNOSIS
REFERENCES
1. Prystowsky EN, Klein GJ. Cardiac Arrhythmias. An Integrated Approach for the Clinician. New York: McGraw-Hill, 1994:155-156.
Accelerated idioventricular rhythm with 1:1 ventricular-atrial conduction; a single supraventricular premature complex.
At the Louisiana State University Health Sciences Center in New Orleans, Dr. Ababneh is an interventional cardiology fellow, Dr. Subramaniam is a professor of medicine (cardiology), and Dr. Glancy is an emeritus professor of medicine (cardiology).
The wide (0.16 seconds) QRS complexes occurred regularly at a rate of 103 beats per minute, had a rightward axis, and were not typical of right or left bundle branch block. Retrograde P waves closely followed each QRS, were negative in the inferior leads and leads V5, and V6, and were positive in leads V1, V3, aVL, and aVR. The patient had experienced a similar episode of accelerated idioventricular rhythm 3 weeks earlier and had spontaneously reverted to sinus bradycardia at a rate of 56 beats/minute. His P waves then were upright, broad (0.15 seconds) and notched in most leads, and the initial component in lead V1 was upright and tall. These changes suggested biatrial enlargement with interatrial block. The PR interval was long (0.25 seconds). The QRS complexes, ST segments, and T waves were normal (Figure 2). Accelerated idioventricular rhythm looks like ventricular tachycardia, but with a slower rate (50-110 beats/min). 1 It usually occurs inpersonwithheart diseasebut is less ominous thanmore rapid ventricular tachycardias. As in this patient, accelerated idioventricular rhythm has often reverted spontaneously to sinus rhythm. 1
110 J La State Med Soc VOL 169 JULY/AUGUST 2017
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