Journal of Surgery and Trauma

en Case Studies on Idioventricular Rhythm in Pediatric Patients: Clinical Insights and Outcomes جراحی قلب Heart Surgery پژوهشي Research Abstract Accelerated Idioventricular rhythm (AIVR), an ectopic ventricular rhythm with rates of 50–120 beats/minute, is a rare arrhythmia in pediatric populations, often secondary to cardiac or systemic conditions. This review synthesizes current evidence on AIVR pathophysiology, diagnosis, and management, supplemented by four illustrative pediatric case studies. The AIVR arises from enhanced ventricular automaticity or triggered activity, commonly linked to ischemia, electrolyte imbalances, or systemic illness. While typically self-limiting, it may manifest in diverse clinical contexts, including chemotherapy-induced cardiotoxicity, acute rheumatic fever, post-surgical interventions, and post-viral myocarditis. We present four unique cases: 1.         A 5-year-old with acute lymphoblastic leukemia (ALL) and cardiac arrest due to myocardial leukemic infiltration. 2.         A 14-year-old with acute rheumatic fever (ARF) and aortic insufficiency (AI), demonstrating AIVR resolution with anti-inflammatory therapy. 3.         A 3-year-old developing transient AIVR post-surgical atrial septal defect (ASD) closure. 4.         A 7-year-old with post-COVID myocarditis and AIVR managed conservatively. Diagnosis relies on electrocardiographic findings (e.g., wide QRS complexes and fusion/capture beats), while echocardiography and cardiac MRI aid in identifying structural or inflammatory contributors. Management prioritizes treating underlying etiologies (e.g., correcting electrolyte imbalances, addressing cardiotoxicity) over direct arrhythmia suppression, as AIVR often resolves spontaneously. Anti-arrhythmic are generally avoided due to hemodynamic risks, though atropine may enhance sinus rhythm in symptomatic cases. These cases underscore the importance of tailored approaches, vigilant monitoring in high-risk populations (e.g., post-surgical or systemic illness), and recognition of AIVR as a potential marker of myocardial stress. While AIVR is usually benign, its presence warrants thorough evaluation for occult pathology. Further research is required to optimize long-term management in pediatric cohorts. Key words: Arrhythmia, Cardiac Surgery, Pediatrics Arrhythmia, Cardiac Surgery, Pediatrics 170 174 http://jsurgery.bums.ac.ir/browse.php?a_code=A-10-478-1&slc_lang=en&sid=1 Feisal Rahimpour feisalrahimpoor@gmail.com 100319475328460012964 100319475328460012964 Yes Department of Pediatric Cardiology, Interventional Electrophysiologist, Mashhad Cardiovascular Medical & Research Center, Mashhad, Iran. Hasan Birjandi BirjandiH@mums.ac.ir 100319475328460012965 100319475328460012965 No Department of Pediatric Cardiology, Interventional Fellowship, Mashhad Cardiovascular Medical & Research Center, Mashhad, Iran. elahe Heidari HeidariE@mums.ac.ir 100319475328460012966 100319475328460012966 No Department of Pediatric Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran