Idioventricular Rhythm: An Insight

Introduction

A patient with idioventricular rhythm usually has a slow, steady heartbeat, a heart rate of less than 50, no P waves, and a lengthy QRS interval. Latent pacemakers activate in response to increased activity and produce escape beats that can be atrial, junctional, or ventricular when the sinoatrial node is inhibited or blocked. It's typically referred to as idioventricular rhythm when ventricular rhythm takes over. "Slow ventricular tachycardia" is another term for idioventricular rhythm, which is akin to ventricular tachycardia but occurs at a rate lower than 60 bpm. Rapid idioventricular rhythm is the term used to describe a pace between 50 and 110 beats per minute.

What Is Idioventricular Rhythm?

This condition is idioventricular rhythm when the lower heart chambers beat more slowly than usual. If the upper chambers' natural pacemaker cannot pace the heart, the lower chambers or ventricles of the heart may begin beating in this kind of rhythm.

Idioventricular rhythm occurs when heartbeats are fewer than 50 beats per minute, in contrast to ventricular tachycardia, which beats more than 100 beats per minute. Beats per minute range from 50 to 110, with an accelerated idioventricular rhythm.

What Causes Idioventricular Rhythm?

Numerous aetiologies can cause idioventricular rhythm to manifest and intensify.

• It often manifests as atrioventricular (AV) dissociation following an advanced or total heart block or when the AV junction cannot generate an "escape" rhythm following a sinus arrest or sinoatrial nodal block.

• When a myocardial infarction is recovering, idioventricular rhythm can also be observed, particularly in those who are on thrombolytic treatment.

• Idioventricular rhythm may be more likely in cases of electrolyte imbalance.

• A number of medicines have been identified as etiological variables in individuals with AIVR, including Cocaine, Beta-adrenoreceptor agonists like Isoprenaline and Adrenaline, anesthetic agents like Desflurane and Halothane, and other pharmaceuticals at dangerous doses like Digoxin.

• Rarely, idioventricular rhythm can also arise in babies with congenital cardiac conditions and cardiomyopathies, including arrhythmogenic right ventricular dysplasia and hypertrophic cardiomyopathies.

• In people who show no signs of heart illness, accelerated idioventricular rhythm is also uncommon. The sympathetic tone is downregulated, while the vagal tone is elevated as part of the process.

Who Does Idioventricular Rhythm Affect?

A person with an idioventricular rhythm may:

• Possess an advanced or total heart block.

• Have a nodal block in the sinuses or sinus arrest.

• Go into cardiac arrest.

• Utilize illicit substances and certain medicines.

• Have an uncommon congenital cardiac condition, meaning it exists from birth.

Accelerated idioventricular rhythm is a condition that can occur in athletes and healthy individuals, although many individuals who have this aberrant rhythm may also have:

• Heart failure due to ischemia (ICM).

• Cardiac rheumatism.

• Dilated cardiomyopathy.

• Sudden cardiac arrests.

• Acute myocarditis.

How Is Idioventricular Rhythm Diagnosed?

In addition to performing a physical examination, the healthcare practitioner will inquire about the medical history of the patient and the family.

To determine whether a person has an idioventricular rhythm, they could perform the following tests:

1. Holter monitor.

2. Diagnosis requires electrocardiography with clinical correlation.

• Ventricular rhythm is regular, but atrial rhythm is absent.

• Rate: For idioventricular rhythm, it is fewer than 40 beats per minute.

• For rapid idioventricular rhythm, rate between 50 and 110 bpm.

• Widespread QRS complex (more than 0.10 seconds).

What Pathophysiology is Associated with Idioventricular Rhythm?

The sinoatrial node serves as the heart's physiological pacemaker. The AV node may operate as the pacemaker if the sinoatrial node becomes faulty. If one of these fails, the heart's ventricles take over as the primary pacemaker. Idioventricular rhythm is produced by the ventricles functioning as their pacemaker.

What Symptoms Are Associated With Idioventricular Rhythm?

Idioventricular rhythm patients often do not exhibit any symptoms. If so, they consist of:

• Weariness.

• Light headedness

• Becoming unconscious.

• Palpations in the heart.

What Treatment Modalities Are Used to Treat Idioventricular Rhythm?

The majority of idioventricular rhythms are benign, and there is no benefit to therapy in terms of prognosis or symptoms.

• Idioventricular rhythm care entails managing myocardial ischemia and any structural or functional issues with the heart and addressing any underlying causal etiology, such as reversing digoxin toxicity if it is present.

• Occasionally, a patient may exhibit symptoms and become intolerant of idioventricular rhythm due to degenerative ventricular fibrillation, rapid ventricular rate, or atrioventricular dyssynchrony. Patients undergoing medical therapy for biventricular failure, which includes increasing sinus rate and atrioventricular (AV) conduction, may also benefit from restoring the atrial kick-using mechanism. In these kinds of situations, Atropine could be tested.

• Medication like Verapamil or Isoproterenol may also be taken with antiarrhythmic drugs like Amiodarone and Lidocaine. Atrial pacing may be a possibility in very uncommon cases.

• Idioventricular rhythm has not been demonstrated to be less likely to develop in reperfusion following myocardial ischemia or cardiomyopathy when beta-blockers are used.

How Does One Reduce the Risk of Developing Idioventricular Rhythm?

Idioventricular rhythms are usually not dangerous. However, there are a few things one can do to lower their risk:

• Eat heart-healthy meals and exercise.

• Maintain proper electrolyte levels.

Conclusion

An arrhythmia that starts in an ectopic location in the ventricles is known as an idioventricular rhythm. These rhythms arise from a malfunctioning primary cardiac pacemaker. Depending on the underlying etiology or causative mechanism causing the rhythm, the indications and symptoms of idioventricular or accelerated idioventricular rhythm might vary. Most of the time, cardiac monitoring is used to diagnose asymptomatic patients.

Palpitations, vertigo, exhaustion, and syncope are rare side effects that individuals may experience. With a decent prognosis, idioventricular rhythm is often benign and does not require therapy. Arrhythmia normally resolves independently when the sinus frequency rises above the ventricular foci and does not need to be treated. Usually, idioventricular rhythm is benign, but providing patients with the right information and comfort is vital.