Accelerated Idioventricular Rhythm Research Articles

Intracardiac echocardiography-guided catheter ablation of highly symptomatic accelerated idioventricular rhythm originating from the right ventricular apical diverticulum.

Ventricular diverticula are saccule-like structures formed by the protrusion of the ventricular myocardium from the endocardial surface towards the free wall. Most diverticula are muscular structures, and patients usually have no obvious clinical symptoms. However, diverticula may contribute to arrhythmogenesis due to localized myocardial structural disturbances. Right ventricular apical diverticulum (RVAD) is very rare, and we report a case of highly symptomatic accelerated idioventricular rhythm (AIVR) originating from the RVAD that underwent intracardiac echocardiography (ICE)-guided catheter ablation with no recurrence during follow-up.

Critical Management of Accelerated Idioventricular Rhythm in Emergency Sitting, Review Article

The terminology "accelerated idioventricular rhythm" refers to an ectopic ventricular rhythm with three or more consecutive premature ventricular monomorphic beats with slow onset and end. That is slower than ventricular tachycardia but faster than the typical intrinsic escape rate of the ventricles, which is 30 to 40 beats per minute. Accelerated idioventricular rhythm differentiates from ventricular tachycardia in addition to having a positive outcome, a long coupling period at the beginning, a gradual drop-in ventricular rate at the conclusion, and an increase in sinus rate. After thrombolysis upon acute myocardial infarction, its presence is a sign that reperfusion was successful. Since malignant ventricular tachycardias are not commonly linked with accelerated idioventricular rhythm and the condition is typically hemodynamically well tolerated, no special therapy is typically required beyond managing the underlying heart condition. Accelerated idioventricular rhythm (AIVR) is usually benign, transitory, and untreatable. The goal of this observational study is to learn more about the clinical signs, prognosis, and therapy of frequent AIVR.

Ventricular Arrhythmias in Patients Undergoing Primary Percutaneous Coronary Intervention (PCI) for ST-Segment Elevation Myocardial Infarction (STEMI)

Objective: To determine the frequency of ventricular arrhythmias in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) at a tertiary care hospital in Karachi, Pakistan. Material and Methods: This descriptive case series study was done at the National Institute of Cardiovascular Disease, Karachi. All patients of either gender having an age between 18 and 70 years of diagnosis with STEMI undergoing primary PCI were included. All the patients were kept under observation for 72 hours in the hospital, and ventricular arrhythmias such as Accelerated Idioventricular Rhythm (AIVR), Frequent PVCs (premature ventricular contractions), Non-Sustained Ventricular Tachycardia, Sustained Ventricular Tachycardia, and Ventricular Fibrillation were recorded. Results: The mean age of the patients was 54.72 ±10.75 years. The majority of the patients, 75.2%, were males and 24.8% were females. The frequency of ventricular arrhythmia was found in 89 (25.9%) of the patients. Among 89 patients with ventricular arrythmia, AIVR was found in 30 (33.71%), frequent PVCs in 18 (20.22%), non-sustained ventricular tachycardia in 23 (25.84%), sustained ventricular tachycardia and ventricular fibrillation in 9 (10.11%) each. Conclusion: As per the study conclusion, the ventricular arrhythmias was observed to be considerably higher among patients undergoing primary PCI for ST-STEMI. Keywords: Ventricular arrhythmias, PCI, ST-segment elevation MI

In-hospital Outcomes of Primary Percutaneous Coronary Intervention in Patients Presenting with acute ST Elevation Myocardial Infarction in a Tertiary Care Hospital in Karachi

Background: Although primary percutaneous coronary intervention (PPCI) is now frequently performed in Pakistan, there is little data available regarding its outcomes in tertiary care hospitals of Pakistan. This study was designed to determine the outcomes, and assess the factors influencing these outcomes of PPCI.
 Methods: It is a retrospective study conducted on the data of patients who presented to the department of Cardiology, Dr. Ruth K.M. Pfau Civil Hospital Karachi from October 2017 to March 2019 with acute ST-elevation myocardial infarction (STEMI) and underwent PPCI. A total of 115 patients were included in this study.
 Results: Out of the 115 patients, 111 had a successful PPCI. The total mortality was 2.6% (3 deaths). One of the patients was reported to have a stent thrombosis. No emergency coronary artery by-pass graft (CABG) was performed and none of the patients had a stroke or any major bleeding. An accelerated idioventricular rhythm (AIVR) was noted in 23 (20%) of the patients. Pre-procedure 87% of the patients had thrombolysis in myocardial infarction (TIMI) grade 0 and only 11.3% were having TIMI flow grade 1. Post procedure a vast majority of the patients (97%) achieved TIMI flow grade 3.
 Conclusions: Our study reports a very high success rate of PPCI which is consistent with the data reported from the Western countries. A major limitation of our study was the relatively small sample size. A larger sample size would have better predicted outcomes considering this is one of the few such studies in this region. Further studies with larger sample size and long-term follow up outcomes are recommended.

Reperfusion Arrhythmia in Acute Myocardial Infarction: Clinical Implication and Management

Reperfusion is a critical component of myocardium survival in acute myocardial infarction to minimize infarct size and improve clinical prognosis. Reperfusion, on the other hand, may result in increased and accelerated myocardial injury, a condition known as reperfusion injury. Following reperfusion, several arrhythmias are observed, and it is called reperfusion arrhythmia. Reperfusion arrhythmia is one manifestation of reperfusion injury. Numerous modest studies have evaluated what reperfusion arrhythmias are defined. It is described as an arrhythmia that occurs immediately or within the first minutes after coronary blood flow is restored. Traditionally, Accelerated Idioventricular Rhythm (AIVR) has been seen as a reperfusion arrhythmia. However, reperfusion may reveal any arrhythmia (or none at all); conversely, AIVR may occur in the absence of reperfusion. Calcium excess within the cells is thought to be a significant factor in the development of reperfusion arrhythmias. This may affect the significant delay following depolarization and the regional heterogeneity of regional blood flow restoration inside the ischemic zone, resulting in reperfusion arrhythmia. In some studies, it was mentioned that these arrhythmias may be due to ongoing myocardial cell damage and ischemia. Arrhythmias associated with reperfusion require special attention since hemodynamics can deteriorate quickly. In this review, clinical significance and management of reperfusion arrhythmia, as well as its link with reperfusion injury will be discussed.

Effectiveness of t-PA in Patients with Acute Myocardial Infarction

Tissue plasminogen activator (t-PA) had improve the treatment of ST elevation myocardial infarction (STEMI). The aims considered assessment the response of patients with STEMI to t-PA (Alteplase) infusion by estimate the frequency of selected parameters. This is study that included 62 patients with STEMI who had been treated with t-PA infusion as a thrombolytic therapy. They had been selected from those who had been admitted to the Coronary Care Unit at Al-Diwaniya Teaching Hospital, Diwaniya city, Iraq during the period between 1st of March 2014 to the 31st of August 2015. Specific selected parameters used to assess effectiveness of t-PA. Parameters including: resolution of ST segment elevation (reduction in the ST elevation ? 50%), relieve of chest pain, occurrence of accelerated idioventricular rhythm (AIVR) and positive response for three parameters (simultaneously), observe within 90 minutes after t-PA infusion. After t-PA infusion, 59.6% of the patients had resolution of ST segment elevation, 56.4% getting relieve of chest pain, AIVR occur in 30.6% and positive response of all parameters in 9.6%. Patients less than 60 years old age constitutes 45.1% of patients who had ST segment resolution, 30.6% of patients who had relieve of chest pain, patients with AIVR in 22.5%, and patients with positive response of all three parameters in 9.6%, (significant p.value). Smokers patients getting ST segment resolution in 41.3% of patients, relieve of chest pain in 38.7%, AIVR in 16.12% and positive response for all selected parameters in 8.06% of patients, (significant p.value). 1.61% of patients with ST segment resolution and 11.29% of patients with relieve of chest pain seen with time to perfusion more than 6 hours. This study indicated that increasing age, obesity, diabetes mellitus (DM), and delay in reaching hospital after onset of ischemic chest pain considered as predictors for poor response to t-PA infusion among patients with STEMI. BMI has no significant consideration but smokers patients had been associated with better response to t-PA.

Prenatal diagnosis and prognosis of accelerated idioventricular rhythm

As postnatal identification of accelerated idioventricular rhythm (AIVR) relies on specific electrocardiographic patterns, prenatal diagnosis of this condition is challenging and its true incidence is unknown. The objectives of this study were to evaluate the performance of prenatal ultrasonography in identifying intrauterine cardiocirculatory events linked to specific electrocardiographic signs of postnatal AIVR, including left or right ventricular origin, and to assess the prenatal prognosis of this arrhythmia. We reviewed Doppler tracings from the superior vena cava/ascending aorta (SVC/Ao), ductus venosus (DV), ductus arteriosus (DA) and aortic isthmus (AoI), as well as simultaneous M-mode recordings of septal and left ventricular wall motions of fetuses diagnosed with AIVR from January 2004 to December 2014. Three cases of AIVR were identified among 27 912 fetuses. SVC/Ao Doppler flow recordings revealed atrioventricular dissociation (ventricular rates within 20% of atrial rates) in all three fetuses and episodes of isorhythmic atrioventricular dissociation in one, while M-mode confirmed normal left ventricular shortening fraction in all cases. Fusion beats were observed on AoI tracing in one fetus, while simultaneous recordings of AoI and DA revealed signs of right bundle branch block in one case and left bundle branch block in the other two. On DV Doppler recordings, retrograde a-waves in the presence of simultaneous atrial and ventricular contractions were observed in all three fetuses, leading to an increase in central venous pressure in all and hydrops fetalis in two cases without evidence of ventricular dysfunction. Echocardiographic criteria required for postnatal diagnosis of AIVR can be documented in utero using specific ultrasonographic approaches. During fetal life, AIVR may not be a benign entity. Hydrops fetalis is frequently associated with AIVR because of increase in central venous pressure related to simultaneous atrioventricular contractions; thus, the ultrasonographic investigation protocol of fetuses with unexplained hydrops fetalis should aim at ruling out AIVR and include Doppler flow recordings in SVC/Ao, DV, AoI, DA and umbilical vein. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Accelerated idioventricular rhythm requiring catheter ablation in a child: The dark side of a benign arrhythmia

A 12 year-old boy, with no history of cardiac disease, was referred to our department for evaluation of an incessant accelerated idioventricular rhythm (AIVR) complicated with severe left ventricular (LV) dysfunction and cardiogenic shock. Extensive diagnostic work-up failed to reveal any structural heart disease. During electrophysiological study, AIVR originated from the right ventricular endocardial anterior wall and was successfully ablated using remote magnetic navigation. LV function showed complete recovery four weeks after the procedure. This case highlights a life-threatening evolution of an arrhythmia generally presented as a benign entity in children.

Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia.

Accelerated idioventricular rhythm (AIVR) or ventricular tachycardia (VT) originating from the right bundle branch (RBB) is rare and published clinical data on such arrhythmia are scarce. In this study, we will describe the clinical manifestations, diagnosis, and management of a cohort of patients with this novel arrhythmia. Eight patients (5 men; median age, 25 years) with RBB-AIVR/VT were consecutively enrolled in the study. Pharmacological testing, exercise treadmill testing, electrophysiological study, and catheter ablation were performed in the study patients, and ECG features were characterized. All RBB-AIVR/VTs were of typical left bundle-branch block morphology with atrioventricular dissociation. The arrhythmias, which demonstrated chronotropic variability, were often isorhythmic with sinus rhythm and were accelerated by physical exercise, stress, and intravenous isoprenaline infusion. The rate of RBB-AIVR/VT varied from 45 to 200 beats per minute. Two patients experienced syncope, and 3 had impaired left ventricular function. Metoprolol was proven to be the most effective drug to decelerate the arrhythmia rate and relieve symptoms. Electrophysiology study was performed in 5 patients and the earliest activation with a sharp RBB potential was localized in the mid or distal RBB area. Catheter ablation terminated the arrhythmia with subsequent RBB block morphology during sinus rhythm. During follow-up, patients' symptoms were controlled with normalization of left ventricular function either on metoprolol or by catheter ablation. RBB-AIVR/VT is an unusual type of ventricular arrhythmia. It can result in significant symptoms and depressed ventricular function and can be successfully treated with catheter ablation.

Transient post-reperfusion left bundle branch block and accelerated idioventricular rhythm with paradoxical QRS narrowing

Accelerated idioventricular rhythm (AIVR) commonly follows coronary reperfusion and has been called a “reperfusion arrhythmia”. Transient left bundle branch block (LBBB) is only rarely seen after interventional reperfusion and is usually considered a procedural complication. We report herein electrocardiograms (ECGs) in a case of acute lateral myocardial infarction which demonstrate both post-perfusion AIVR and a simultaneous transient LBBB with fusion complexes causing paradoxical QRS narrowing.

The effect of thrombolytic therapy on QT dispersion in acute myocardial infarction and its role in the prediction of reperfusion arrhythmias

We aimed to determine the effect of intravenous thrombolytic therapy on QT dispersion (QTd) and its role in the prediction of reperfusion arrhythmias. Twenty patients with acute myocardial infarction (MI) were enrolled in the study. Measurements of QTd were carried out prior to thrombolytic therapy and before discharge. The patients were examined for ventricular arrhythmias with 24-h Holter electrocardiography monitoring after treatment and the relationship between ventricular arrhythmias and the QTd values in the early phase of MI was investigated. The values of QTd were significantly higher during the early phase of MI (60 ± 5.32 ms) than those in the late phase (53.35 ± 4.07 ms) (P = 0.032). There was no correlation between isolated, bigeminal, trigeminal and total ventricular premature beats, accelerated idioventricular rhythm (AIVR) with QTd values. However, the patients with sustained ventricular tachycardia (VT), prolonged VT and sustained AIVR had higher corrected QTd (92 ms 1/2 , 97.8 ms 1/2 , 81.7 ms 1/2 , respectively) than the patients without these arrhythmias (74 ms 1/2 , 56.3 ms 1/2 , 58.28 ms 1/2 , respectively) (P = 0.022, 0.013, 0.018). The values of QTd may be significantly reduced in the 1 st week of acute MI and measurement of QTd in the early phase of MI may have a correlation with the following reperfusion arrhythmias: Sustained VT, prolonged VT and AIVR.

Spontaneous coronary dissection presenting with reperfusion arrhythmia: A case report

Spontaneous coronary dissection is more commonly reported in females and is an important differential diagnosis for acute coronary syndrome. Accelerated idioventricular rhythm has been reported before with reperfusion post myocardial ischemia. We report a case of accelerated idioventricular rhythm in a patient with spontaneous coronary artery dissection. A 45-year-old Caucasian female presented with left sided chest pain radiating to the neck and palpitations. Admission ECG showed accelerated idioventricular rhythm. Troponin I peaked at 0.5 ng/ml. Coronary angiography showed mid to distal left anterior descending artery dissection with adequate distal flow. Patient was initially medically managed with aspirin, metoprolol, intravenous heparin and eptifibatide infusions but continued to have symptoms of unstable angina. She underwent successful percutaneous coronary intervention with 2 drug eluting stents and was discharged back home symptom free on dual platelet therapy. Spontaneous coronary artery dissection is an important differential diagnosis for acute coronary syndrome especially in younger females. Accelerated idioventricular rhythm can be a presentation of coronary dissection and may indicate instability. Early percutaneous coronary intervention should be considered in such patients.

Accelerated idioventricular rhythm associated with propranolol treatment in a child

Accelerated idioventricular rhythm (AIVR) is a ventricular arrhythmia most commonly seen in adults with underlying cardiac disease. It is important to establish the diagnosis when it occurs to differentiate this benign phenomenon from dangerous ventricular tachycardia. We present the case of a healthy child who developed episodes of AIVR associated with propranolol treatment. Her 24-hour electrocardiography recording showed AIVR with difference between sinus and ventricular beats. The arrhythmia resolved with the discontinuation of propranolol, and eventually the case was in sinus rhythm. This patient is the first case of AIVR associated with propranolol treatment in the literature.

Catheter ablation of long-lasting accelerated idioventricular rhythm in a patient with mild left ventricular dysfunction.

A 35-year-old woman with long-lasting accelerated idioventricular rhythm (AIVR) exhibited palpitation and dyspnea on exertion and mild left ventricular (LV) dysfunction during followup. Symptoms appeared 10 years after the AIVR was first noted, and she underwent catheter ablation for curative therapy of AIVR after 12 years. Radiofrequency ablation of the anteroseptal site of the LV at the earliest activation terminated rhythm. An echocardiogram, taken 1 month after discharge, subsequently revealed that the left ventricular wall motion had normalized. This is a rare case of long-lasting AIVR with mild LV dysfunction.

Acute haemodynamic effects of accelerated idioventricular rhythm in primary percutaneous coronary intervention

Accelerated idioventricular rhythm (AIVR) is very frequently observed in primary percutaneous coronary intervention (PCI), however knowledge of the haemodynamic effects is lacking. We studied an ST-segment elevation myocardial infarction cohort of 128 consecutive patients (aged 62±11 years) in whom AIVR occurred following reperfusion during primary PCI. Mean systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate were determined during periods of AIVR and sinus rhythm. We grouped patients according to the infarct-related artery and the site of the coronary occlusion. AIVR caused an immediate reduction in SBP (130±27 vs. 98±22 mmHg, p<0.001) and DBP (80±19 vs. 69±16 mmHg, p<0.001) and a small increase in heart rate (78±12 vs. 83±11 bpm, p<0.001) as compared to sinus rhythm, irrespective of infarct-related artery. Both absolute as well as relative reduction in SBP were more pronounced in distal than proximal left coronary artery (LCA) occlusions (36±16 vs. 27±12 mmHg, p<0.01, respectively 25±9 vs. 20±8%, p<0.05). These haemodynamic differences between proximal and distal occlusion sites were not observed in the right coronary artery. AIVR following reperfusion is associated with marked reduction in both SBP and DBP, irrespective of infarct-related artery. These haemodynamic effects are accompanied by only a very modest increase in heart rate during AIVR. Patients with a culprit lesion in the proximal LCA showed a smaller reduction in systolic blood pressure than distal LCA lesions.

Bidirectional fascicular tachycardia with alternating axis deviation following acute myocardial infarction

A 46-year-old male without past medical history presented to the emergency department complaining of severe chest pain. Blood pressure was 100/70 mm Hg, heart rate was 66 bpm, and the oxygen saturation was normal. The 12-lead ECG showed ST segment elevation in leads I, avL and throughout the precordial leads (Fig. 1A). Urgent coronary angiography was performed and demonstrated a complete thrombotic occlusion of the mid left anterior descending artery (LAD) as well as a more proximal 70% luminal narrowing of the LAD. Percutaneous transluminal coronary angioplasty and stent implantation of the mid LAD was successfully performed with restoration of grade TIMI 3 flow in the LAD. The patient was admitted to the cardiac intensive care unit after successful stent implantation. ECG performed 1 h after reperfusion (Fig. 1B) showed a wide complex tachyarrhythmia with right bundle branch block (RBBB) morphology and alternating axis deviation. This arrhythmia spontaneously resolved to normal sinus rhythm (Fig. 1C). The patient was discharged with medical therapy including a beta blocker and without any complications. The 12-lead ECG recording demonstrates a bidirectional tachycardia in which all the beats have features of RBBB and the QRS axis in the frontal plane alternates between right and left axis deviations (Fig. 1B). The width of the QRS complex is only 110 ms, thus corresponding to a tachycardia originating within the left bundle branch (LBB) or its fascicles. The illustration (Fig. 2) is based on the assumption that the focus of the tachycardia was situated in the left bundle just above the division into the left posterior fascicle (LPF) and the left anterior fascicle (LAF) with impulses conducting to the myocardium using the LAF and LPF alternately, hence the alternating axis. Even though His bundle potentials were not recorded during the bidirectional tachycardia, the relatively narrow width of the QRS and the alternating axis together with RBB leaves no doubt regarding the location of the automatic focus in the territory of the LBB. This concept was documented by His bundle recordings by Massumi back as 1973 [1] and by clinical observations since 1977 [2]. The QRS morphology and rate of arrhythmia corresponds to the majority of the cases of reperfusion arrhythmias also known as accelerated idioventricular rhythm (AIVR) [3]. However, the unique feature is the alternation of the QRS axis in the frontal plane suggesting functional block in the two fascicles. As is usually the case, the tachycardiawas self-limited and resolved spontaneously. The majority of the AIVR cases have rates under 120/min and do not cause hemodynamic deterioration. However, it is important to distinguish the reperfusion AIVR from the more dangerous type of bidirectional ventricular tachycardia (VT) seen in the course of digitalis intoxication [4] and severe myocardial damage such as myocarditis [5]. This patient had no history of digitalis use and the arrhythmia occurred during the reperfusion period making bidirectional VT very unlikely. Bidirectional VT has not been reported in the setting of acute myocardial infarction. It should also be noted that the early publication of cases of AIVR emphasized the point that the occurrence of AIVR usually indicated restoration of flow to the infarcted region [3]. In recent publications, it has been reported that AIVR also appears in several drug intoxications [3], post-resuscitation [6] and idiopathic dilated cardiomyopathy [7]. There is general agreement that the electrophysiological mechanism of AIVR is enhanced automaticity of the His bundle and/or its divisions. To the best of our knowledge, this is the first report of alternating LAF and LPF block in the setting of the RBBB and fascicular rhythm in a patient with acute anterior myocardial infarction. The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [8].

Prevalence and Significance of Accelerated Idioventricular Rhythm in Patients With ST-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Accelerated idioventricular rhythm (AIVR) has been considered a marker of successful reperfusion in fibrinolytic-treated patients. Evidence is limited regarding its significance in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PPCI). The purpose of the present study was to determine the prevalence and associated outcomes of arrhythmias and conduction disturbances occurring during PPCI. In 503 patients with ST-elevation myocardial infarction, the arrhythmias and conduction disturbances occurring from arrival at the catheterization laboratory to 90 minutes after PPCI were registered. Continuous ST-monitoring was performed to determine the interval from the first wire to complete ST resolution. The area at risk was evaluated in the acute phase and the final infarct size (FIS) after 1 month using myocardial perfusion imaging. Mortality was registered at a median follow-up of 2.9 years. The most common arrhythmias observed during PPCI were AIVR (42%), sinus bradycardia (28%), and nonsustained ventricular tachycardia (26%). The arrhythmias associated with the FIS included AIVR (unstandardized regression coefficient [B] = 5.27, p <0.001), sustained ventricular tachycardia (B = 15.7, p <0.001), and sinus bradycardia (B = -4.12, p = 0.001). Right bundle branch block was the only conduction disturbance associated with FIS (B = 7.17, p = 0.001). Patients with AIVR less often achieved spontaneous ST resolution before PPCI (13% vs 36%, p <0.001), less often had Thrombolysis In Myocardial Infarction flow 3 on admission (3% vs 33%, p <0.001), had a larger area at risk (35% vs 23% of the left ventricle, p <0.001), had a longer time to complete ST resolution (39 vs 21 minutes, p <0.001), had a larger FIS (13% vs 5% of the left ventricle, p <0.001) but had similar mortality (8.6% and 6.5%, p = 0.39) compared to patients without AIVR. In conclusion, AIVR is the most frequent arrhythmia occurring during PPCI in patients with ST-elevation myocardial infarction. However, it is not a marker of successful reperfusion but is associated with extensive myocardial damage and delayed microvascular reperfusion.

Effects of left ventricular unloading on reperfusion-related AIVR in acute myocardial infarction

Accelerated idioventricular rhythm (AIVR) often occurs in the setting of acute myocardial infarction, specifically after reperfusion. We studied the direct left ventricular (LV) dynamic effects of AIVR compared with sinus rhythm. Furthermore, we observed an interesting finding of LV unloading on the occurrence of AIVR.

In‐hospital arrhythmias in patients with acute myocardial infarction—the relation to the reperfusion strategy and their prognostic impact

Arrhythmias are frequent complication in patients with acute myocardial infarction (MI). The importance of accelerated idioventricular rhythm (AIVR), ventricular fibrillation or tachycardia (VF, VT), atrial fibrillation or flutter (AF) and bradycardias is considered and discussed in this review article. The value of the presence of AIVR as a marker of reperfusion is small, but in combination with other non-invasive markers (ST-segment resolution), its presence is connected with a high probability of successful reperfusion. Early ventricular arrhythmias are a serious complication of MI. However, if they are revealed and treated in time, they apparently do not represent a negative prognostic factor. Later occurred VF or VT are more a symptom of larger MI. AF, which is not directly life-threatening for the patients, frequently occurs in patients with larger MI and it is an independent predictor of a poor long-term prognosis of these patients. The early and successful reperfusion therapy is the best anti-arrhythmic therapeutic method in patients with MI.

Frequent accelerated idioventricular rhythm in a young male of Buerger's disease with acute myocardial infarction

Buerger's disease is a small and medium vessel vasculitis that predominantly involves the distal extremities. Coronary involvement is rarely reported. We reported a 32 year-old man with Buerger's disease (thromboangiitis obliterans) suffering from acute anterior chest pain and V 1–6 ST-segment elevation. Frequent episodes of accelerated idioventricular rhythm (AIVR) were found during initial admission. Emergent coronary angiography revealed thrombus inside the proximal left anterior descending coronary artery and primary percutaneous trasluminal coronary angioplasty and stenting was successfully done after thrombus aspiration. No more AIVR occurred after the procedure. Doctor should be alerted to AIVR as a sign of reperfusion in the acute coronary syndrome even in a young subject.