Volume 14, Issue 3 (8-2026)
J Surg Trauma 2026, 14(3): 170-174 |
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Rahimpour F, Birjandi H, Heidari E. Case Studies on Idioventricular Rhythm in Pediatric Patients: Clinical Insights and Outcomes. J Surg Trauma 2026; 14 (3) :170-174
URL: http://jsurgery.bums.ac.ir/article-1-477-en.html
URL: http://jsurgery.bums.ac.ir/article-1-477-en.html
Department of Pediatric Cardiology, Interventional Electrophysiologist, Mashhad Cardiovascular Medical & Research Center, Mashhad, Iran.
Abstract: (200 Views)
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
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
Type of Study: Research |
Subject:
Heart Surgery
Received: 2026/04/4 | Accepted: 2026/07/11 | ePublished ahead of print: 2026/07/11 | Published: 2026/08/1
Received: 2026/04/4 | Accepted: 2026/07/11 | ePublished ahead of print: 2026/07/11 | Published: 2026/08/1
References
1. Tse G, Yan BP. Traditional and novel risk factors of ventricular arrhythmias and sudden cardiac death in myocardial infarction. J Geriatr Cardiol. 2017;14(2):91. [URL:https://academic.oup.com/europace/article/19/5/712/2952428]
2. Gildea TH, Levis JT. ECG diagnosis: accelerated idioventricular rhythm. Perm J. 2018;22(2):17-3. [DOI: 10.7812/TPP/17-173] [DOI:10.7812/TPP/17-173] [PMID] [PMCID]
3. Ljubas Perčić D, Krmek N, Benko I, Kniewald H, Bitanga S, Katavić M, et al. Frequent accelerated idioventricular rhythm in an otherwise healthy child: a case report and review of literature. BMC Cardiovasc Disord. 2023;23(1):37. [DOI: 10.1186/s12872-023-03074-5] [PMID: 36670379] [DOI:10.1186/s12872-023-03074-5] [PMID] [PMCID]
4. Gildea TH, Levis JT. ECG diagnosis: accelerated idioventricular rhythm. Perm J. 2018;22:17-173. [DOI: 10.7812/TPP/17-173] [PMID: 29616912] [DOI:10.7812/TPP/17-173] [PMID] [PMCID]
5. MacLellan-Tobert SG, Porter CJ. Accelerated idioventricular rhythm: a benign arrhythmia in childhood. Pediatrics. 1995;96(1 Pt 1):122-5. [PMID: 7596699] [DOI:10.1542/peds.96.1.122] [PMID]
6. Ljubas Perčić D, Krmek N, Benko I, Kniewald H, Bitanga S, Katavić M,et al. Frequent accelerated idioventricular rhythm in an otherwise healthy child: A case report and review of literature. BMC Cardiovasc Disord. 2023;23(1):37. [DOI: 10.1186/s12872-023-03074-5.] [PMID: 36670379] [DOI:10.1186/s12872-023-03074-5] [PMID] [PMCID]
7. Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, et al. PACES/HRS Expert Consensus Statement on the Evaluation and Management of Ventricular Arrhythmias in the Child with a Structurally Normal Heart. Heart Rhythm. 2014;11(9):55-78. [DOI: 10.1016/j.hrthm.2014.05.010.] [PMID: 24814375] [DOI:10.1016/j.hrthm.2014.05.010] [PMID]
8. Tse G, Yan BP. Traditional and novel risk factors of ventricular arrhythmias and sudden cardiac death in myocardial infarction.J Geriatr Cardiol. 2017;14(2):91-8. [URL:https://academic.oup.com/europace/article/19/5/712/2952428]
9. Riera AR, Barros RB, de Sousa FD, Baranchuk A. Accelerated idioventricular rhythm: history and chronology of the main discoveries. Indian Pacing Electrophysiol J. 2010;10(1):40-8. [PMID: 20084194]
10. Jose L Merino, Juan Tamargo, Carina Blomström-Lundqvist, Giuseppe Boriani, Harry JGM Crijns, Dobromir Dobrev, et al. Practical compendium of antiarrhythmic drugs: a clinical consensus statement of the European Heart Rhythm Association of the European Society of Cardiology. EP Europace. 2025;27(8):euag076. [DOI: 10.1093/europace/euaf076] [DOI:10.1093/europace/euaf076] [PMID]
11. Ganea G, Cinteză EE, Filip C, Iancu MA, Balta MD, Vătășescu R, et al. Postoperative cardiac arrhythmias in pediatric and neonatal patients with congenital heart disease-a narrative review. Life (Basel). 2023;13(12):2278. [DOI: 10.3390/life13122278] [PMID: 38137879] [DOI:10.3390/life13122278] [PMID] [PMCID]
12. Fishberger S. Management of ventricular arrhythmias in adults with congenital heart disease. Curr Cardiol Rep. 2002;4(1):76-80. [DOI: 10.1007/s11886-002-0130-5] [PMID: 11743926] [DOI:10.1007/s11886-002-0130-5] [PMID]
13. Ljubas Perčić D, Krmek N, Benko I, Kniewald H, Bitanga S, Katavić M, et al. Frequent accelerated idioventricular rhythm in an otherwise healthy child: A case report and review of literature. BMC Cardiovasc Disord. 2023;23(1):37. [DOI: 10.1186/s12872-023-03074-5.] [PMID: 36670379] [DOI:10.1186/s12872-023-03074-5] [PMID] [PMCID]
14. Crosson JE, Callans DJ, Bradley DJ, Dubin A, Epstein M, Etheridge S, et al. PACES/HRS Expert Consensus Statement on the Evaluation and Management of Ventricular Arrhythmias in the Child with a Structurally Normal Heart. Heart Rhythm. 2014;11(9):55-78. [DOI: 10.1016/j.hrthm.2014.05.010. ] [PMID: 24814375] [DOI:10.1016/j.hrthm.2014.05.010] [PMID]
15. Tse G, Yan B P. Traditional and novel risk factors of ventricular arrhythmias and sudden cardiac death in myocardial infarction. J Geriatr Cardiol . 2017;14(2):95. [URL:https://academic.oup.com/europace/article/19/5/712/2952428]
16. Reynolds JL, Pickoff A. Accelerated ventricular rhythm in children: a review and report of a case with congenital heart disease. Pediatric Cardiol. 2001;22(1):23-8. [DOI: 10.1007/s002460010146] [DOI:10.1007/s002460010146] [PMID]
17. Shetty RS, Manavi KM, Shanmugasundaram B, Prabhu SA. Postoperative arrhythmia in pediatric intensive care unit. J Pediatr Crit Care. 2025;12(5):265-74. [DOI:10.4103/jpcc.jpcc_83_25] [DOI:10.4103/jpcc.jpcc_83_25]
18. Mayaya PC, Tinică G, Chistol RO, Moraru L, Damian SI, Frăsinariu OE, et al. Incidence and risk factors for early postoperative arrhythmias in congenital heart disease - systematic review. J Cardiovasc Emerg. 2025;11(2):43-53 [DOI: 10.2478/jce-2025-0005] [DOI:10.2478/jce-2025-0005]
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