A 35-year-old woman was admitted for recurrent palpitations and headache with cold sweats. No structural abnormality was detected via cardiac imaging studies. A standard 12-lead electrocardiogram (ECG) revealed sustained monomorphic ventricular tachycardia (VT). Propranolol (120 mg/day) was administered; however, the frequency and duration of VT episodes increased rapidly. A 24-hr ambulatory ECG revealed frequent, successive, premature ventricular beats; accelerated idioventricular rhythms; and VTs with various cycle lengths and QRS complex morphologies. ECG findings suggested that the observed ventricular arrhythmias were driven by accelerated automaticity as their main electrophysiological mechanism. Based on clinical manifestations and ECG findings, pheochromocytoma was suspected. Solitary left adrenal pheochromocytoma was diagnosed by endocrine and imaging studies. Instead of propranolol, oral doxazosin (8 mg/day) was administered, and symptoms and VT attacks were successfully suppressed. After surgical resection of the pheochromocytoma, clinical VT was not observed in response to the high-dose isoproterenol provocation test.
Accelerated Idioventricular Rhythm ; Adult ; Arrhythmias, Cardiac ; Doxazosin ; Electrocardiography ; Female ; Headache ; Humans ; Isoproterenol ; Pheochromocytoma* ; Propranolol ; Sweat ; Tachycardia, Ventricular* ; Ventricular Premature Complexes

Accelerated idioventricular rhythm is defined as a ventricular rhythm of 60-100 beats per minute or a ventricular tachycardia that does nor exceed 120 beats per minutes. Although, it rarely converts to a fatal arrhythmia like ventricular fibrillation, it needs to be differentiated from AIVR, which is from another origin. AIVR may occur due to ischemic heart disease (ST elevated myocardial infarction), cardiomyopathy, rheumatic fever and digitalis intoxication. We report here on a case of AIVR that was related to desflurane administration.
Accelerated Idioventricular Rhythm ; Anesthesia ; Arrhythmias, Cardiac ; Cardiomyopathies ; Digitalis ; Isoflurane ; Methyl Ethers ; Myocardial Ischemia ; Rheumatic Fever ; Tachycardia, Ventricular ; Ventricular Fibrillation

A 56-year-old man presented with right coronary arterial spasm accompanied by ST segment elevation in the inferior leads. A reperfusion arrhythmia, accelerated idioventricular rhythm (AIVR), developed 1 hour after a nitroglycerin infusion. The AIVR was sustained for 5 days without hemodynamic instability, and resolved spontaneously during hemodynamic monitoring in the coronary intensive care unit.
Accelerated Idioventricular Rhythm ; Angina Pectoris ; Arrhythmias, Cardiac ; Hemodynamics ; Humans ; Intensive Care Units ; Middle Aged ; Myocardial Infarction ; Nitroglycerin ; Reperfusion ; Spasm

Accelerated idioventricular rhythm(AIVR) describes ventricular rates slower than usual tachycardia rates but faster than the ventricular escape rhythm. Ventricular rates of 40- 120 beats/min are usual. Accelerated idioventricular rhythm probably represents enhanced automaticity in the ventricles and manifests itself when sinus rates slow. This arrhythmia has been reported in association with acute myocardial infarction, digitalis excess, cardiomyopathy, and rheumatic heart disease. Only rare case of AIVR without underlying heart disease has been described. It is transient and intermittent, with episodes lasting a few seconds to a minute, and does not appear to seriously affect the patient's clinical course or the prognosis. Suppressive therapy is rarely necessary. Recently, we have experienced four cases of AIVR in children without underlying heart disease with benign clinical course.
Accelerated Idioventricular Rhythm* ; Arrhythmias, Cardiac ; Cardiomyopathies ; Child* ; Digitalis ; Heart Diseases ; Heart* ; Humans ; Myocardial Infarction ; Prognosis ; Rheumatic Heart Disease ; Tachycardia ; United Nations

A 50 year old female presented unusual electrocardiographic changes including AV block, accelerated idioventricular rhythm, ventricular premature systole with severe fluctuation of blood pressure and clinical features of angina pectoris. Deep ST segment depression was demonstrated in spite of the normal coronary arteriogram and the negative coronary artery spasm study. Urinary excretion of catecholamines and their metabolites were elevated and a huge pheochromocytoma was found in the left adrenal glandd. After removal of the pheochromocytoma, the electrocardiographic abnormalities and the blood pressure were normalized and teh aptient became asymptomatic.
Accelerated Idioventricular Rhythm ; Angina Pectoris* ; Arrhythmias, Cardiac ; Atrioventricular Block ; Blood Pressure ; Catecholamines ; Coronary Vessels ; Depression ; Electrocardiography* ; Female ; Humans ; Middle Aged ; Pheochromocytoma* ; Spasm ; Systole

A 38-year-old man presented with typical squeezing-type anterior chest pain. An initial electrocardiogram (ECG) showed prominent ST-segment elevation (V1-V4 lead, 3 mm). Suddenly, the patient fell unconscious and had no pulse. At that time, the ECG showed polymorphic ventricular fibrillation (VT). After direct current (DC) cardioversion, the patient regained vital signs and defibrillation converted the VT into an accelerated idioventricular rhythm with resolution of the ST-segment elevation. The patient was referred to our hospital for close observation and further evaluation. At our hospital, an ECG showed normal sinus rhythms and cardiac enzymes were within normal limits. We diagnosed the patient with variant angina rather than ST elevation myocardial infarction (STEMI), because his clinical manifestations were quite distinct; ST-segment elevations disappeared slowly at the reperfusion stage. However, the patient's final diagnosis was STEMI because coronary angiography showed severe eccentric tubular stenosis (85%) with remnant thrombus in the middle left anterior descending artery. Defibrillation likely removed the thrombus, which led to STEMI.
Accelerated Idioventricular Rhythm ; Adult ; Angina Pectoris, Variant ; Arteries ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Electric Countershock ; Electrocardiography ; Humans ; Myocardial Infarction ; Myocardial Revascularization ; Reperfusion ; Thrombosis ; Unconscious (Psychology) ; Ventricular Fibrillation ; Vital Signs

A 57-year-old man was admitted to the emergency room because of a chest pain for one hour that radiated to the shoulder and arm. The pain was similar to the chest pain he usually had experienced, except for the one hour's duration. Six months before admission, he experienced a chest pain with a squeezing nature, causing central, substernal discomfort. The pain lasted 2 to 5 min. The pain usually occurred between 2 a.m. and 7 a.m. during sleeping, once or twice per month, and was not caused by exertion. He was a heavy smoker. The blood pressure was 100/60mmHg and the pulse rate was 85/min. The remainder of physical examination was normal. Electrocardiogram showed tall and tented T waves in lead V1 through V4. Fourteen minutes after admission, the electrocardiogram changed and showed a left bundle branch block pattern with an ST elevation and tall T waves without P waves in lead V1 through V4. This rhythm was accelerated idioventricular rhythm. The electrocardiogram obtained 23 minutes after admission showed a right bundle branch block pattern with an ST elevation and tall T waves without P waves in lead V1 through V4. He was treated for variant angina with sublingual and intravenous nitroglycerine, with complete resolution of the chest pain. The electrocardiogram obtained after resolution of the chest pain was normal. At the emergency room, the creatine kinase(CK) level was 144 U/L (normal, 55~170) and the troponin T level was 0.033 ng/ml (normal, 0.000~0.100). Eight hours after admission, the CK level was 598 U/L. The coronary angiogram, performed on the fourth hospital day, showed 99% spasm on the proximal left anterior descending artery by intravenous ergonovine provocation test. He was treated with long-acting nitrate and calcium antagonist, and experienced no more chest pain. The final diagnosis of this patient was acute myocardial infarction by variant angina.
Accelerated Idioventricular Rhythm ; Arm ; Arteries ; Blood Pressure ; Bundle-Branch Block ; Calcium ; Chest Pain* ; Creatine ; Diagnosis ; Electrocardiography ; Emergency Service, Hospital ; Ergonovine ; Heart Rate ; Humans ; Middle Aged* ; Myocardial Infarction ; Nitroglycerin ; Physical Examination ; Shoulder ; Spasm ; Thorax* ; Troponin T

PURPOSE: Early postoperative arrhythmias are a major cause of mortality and morbidity after open heart surgery in the pediatric population. We evaluated the incidence and risk factors of early postoperative arrhythmias after surgery of congenital heart disease. METHODS: From January 2002 to December 2008, we retrospectively reviewed the medical records of the 561 patients who underwent cardiac surgery in Kyungpook National University Hospital. We analyzed patients' age and weight, occurrence and type of arrhythmia, cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time, and postoperative electrolyte levels. RESULTS: Arrhythmias occurred in 42 of 578 (7.3%) cases of the pediatric cardiac surgery. The most common types of arrhythmia were junctional ectopic tachycardia (JET) and accelerated idioventricular rhythm (AIVR), which occurred in 17 and 13 cases, respectively. The arterial switch operation (ASO) of transposition of the great arteries (TGA) had the highest incidence of arrhythmia (36.4%). Most cases of cardiac arrhythmia showed good response to management. Patients with early postoperative arrhythmias had significantly lower body weight, younger age, and prolonged CPB and ACC times (P<0.05) than patients without arrhythmia. Although the mean duration of ventilator care and intensive care unit stay were significantly longer (P<0.05), the mortality rate was not significantly different among the 2 groups. CONCLUSION: Early postoperative arrhythmias are a major complication after pediatric cardiac surgery; however, aggressive and immediate management can reduce mortality and morbidity.
Accelerated Idioventricular Rhythm ; Arrhythmias, Cardiac ; Arteries ; Body Weight ; Cardiopulmonary Bypass ; Child ; Heart ; Heart Diseases ; Humans ; Incidence ; Intensive Care Units ; Medical Records ; Retrospective Studies ; Risk Factors ; Tachycardia, Ectopic Junctional ; Thoracic Surgery ; Ventilators, Mechanical

BACKGROUND AND OBJECTIVES: Arrhythmia is known to be a major cause of death in acute myocardial infarction (AMI). Reperfusion arrhythmias (RA) may also occur during angioplasty or thrombolysis. As yet, the clinical significances of RA and angiographic characteristics of the patients who develop RA during primary angioplasty and stenting are not clearly defined. METHODS: The study group consisted of 60 patients treated with primary angioplasty or stenting for AMI (angioplasty 13, stenting 47 patients). The patients were classified into 2 groups according to RA [RA (-) N=36/RA(+) N=24]: demographic and angiographic characteristics including time to reperfusion and incidence of pre-infarct angina were analyzed. RESULTS: The RA occurred in 40% of patients undergoing primary angioplasty or stenting (24/60 patients). The minor arrhythmias were more common after reperfusion (transient bradycardia 14, accelerated idioventricular rhythm 11, premature ventricular contraction 4 cases): major arrhythmias were uncommon (ventricular tachycardia/fibrillation 5, asystole 1 case). In the two groups, baseline clinical characteristics were similar except for pain to reperfusion time [RA (-): RA (+)=490.8+/-291.7: 252.9+/-109.2 minutes, P=0.001]. There was a trend toward a greater incidence of RA in the right coronary infarct-related artery [RA (-): RA (+)=16.7: 41.7%, P=NS]. The RA occurred in totally occluded artery (TIMI 0) with a giant thrombus and first ballooning in 19/24 patients (79.2%). The RA disappeared with conservative managements including pacemaker insertion and cardiopulmonary resuscitation and there were no differences in major adverse cardiac events in the two groups during follow-up. CONCLUSIONS: These findings suggest that the RA are frequent events during primary angioplasty but unrelated to clinical and angiographic characteristics except for reperfusion time and do not influence short-term prognosis in AMI.
Accelerated Idioventricular Rhythm ; Angioplasty* ; Arrhythmias, Cardiac* ; Arteries ; Bradycardia ; Cardiopulmonary Resuscitation ; Cause of Death ; Follow-Up Studies ; Heart Arrest ; Humans ; Incidence ; Myocardial Infarction* ; Prognosis ; Prospective Studies* ; Reperfusion* ; Stents ; Thrombosis ; Ventricular Premature Complexes

We present the case of a 38-year-old woman admitted to our outpatient clinic with accelerating back pain and fatigue following a kick to her back by her husband. Upon arrival, we detected ST segment elevation in the D1, aVL, and V2 leads and accelerated idioventricular rhythm. She had pallor and hypotension consistent with cardiogenic shock. We immediately performed coronary angiography and found a long dissection starting from the mid-left main coronary artery and progressing into the mid-left anterior descending (LAD) and circumflex arteries. She was then transferred to the operating room for surgery. A saphenous vein was grafted to the distal LAD. Since the patient was hypotensive under noradrenaline and dopamine infusions, she was transferred to the cardiovascular surgery intensive care unit on an extracorporeal membrane oxygenator and intra-aortic balloon pump. During follow-up, her blood pressure remained low, at approximately 60/40 mmHg, despite aggressive inotropic and mechanical support. On the second postoperative day, asystole and cardiovascular arrest quickly developed, and despite aggressive cardiopulmonary resuscitation, she died.
Accelerated Idioventricular Rhythm ; Adult ; Ambulatory Care Facilities ; Arteries ; Back Pain ; Blood Pressure ; Cardiopulmonary Resuscitation ; Coronary Angiography ; Coronary Vessels* ; Dopamine ; Fatigue ; Female ; Follow-Up Studies ; Heart Arrest ; Humans ; Hypotension ; Intensive Care Units ; Norepinephrine ; Operating Rooms ; Oxygenators, Membrane ; Pallor ; Saphenous Vein ; Shock, Cardiogenic ; Spouses ; Transplants