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All ECG 20

The ECG shows regular P waves at 60 beats per minute (bpm) with no conduction to the ventricles. The ventricular rate is about 70 bpm with QRS duration of 0.20 and a left bundle branch block (LBBB) pattern. The findings are consistent with accelerated idioventricular rhythm (AIVR). An idioventricular rhythm is similar to ventricular tachycardia (VT), except the ventricular rate is less than 60 bpm. All the other characteristics of VT apply, including the Brugada criteria. Atrioventricular (AV) dissociation with P waves completely unrelated to the QRS is best seen in the V1 rhythm strip. The QRS morphology is a LBBB pattern and is monophasic downward in the precordial leads, another indicator of a ventricular origin of the rhythm. An idioventricular rhythm is sometimes called “slow ventricular tachycardia” or “slow VT.” When the ventricular rate is 60 to 100 bpm, it should be referred to as AIVR.

Related: Idioventricular Rhythm ECG Review, Ventricular Tachycardia ECG Review