QALY | What Accelerated Idioventricular Rhythm Looks Like on Your Watch ECG

Key Takeaways

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Accelerated idioventricular rhythm (AIVR) was first described by Sir Thomas Lewis in 1910. In the AIVR heart rhythm, your lower heart chambers beat slower than normal. With this type of rhythm, your heart’s ventricles or lower chambers may start your heartbeat, if your natural pacemaker located in the upper chambers is unable to pace the heart.

Accelerated idioventricular rhythm (AIVR) is a ventricular rhythm consisting of three or more consecutive wide QRS complexes, with gradual onset and gradual termination. AIVR is usually seen during acute myocardial infarction reperfusion (following thrombolytic therapy or percutaneous coronary intervention), and rarely manifests in people with completely normal hearts or with structural heart disease.

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How to Spot Accelerated Idioventricular Rhythm on Your Watch ECG

Accelerated idioventricular rhythm (AIVR) is traditionally defined as an ectopic rhythm with more than 3 consecutive premature beats, with gradual onset and gradual termination, and usually competitive with the sinus rhythm.

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These are the characteristics of how you identify accelerated idioventricular rhythm:

Rhythm: Regular (in most cases)
P Wave: Absent
PR Interval: Not measurable
QRS: Wide (>0.12 sec), bizarre-looking

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Unlike ventricular tachycardia, which is faster than 100 beats per minute, accelerated idioventricular rhythm has a rate of 60 to 100 beats per minute.

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Example of Accelerated Idioventricular Rhythm caught on Apple Watch

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Example of Accelerated Idioventricular Rhythm caught on Apple Watch, reviewed by QALY

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Common Symptoms of Accelerated Idioventricular Rhythm

Accelerated idioventricular rhythm (AIVR) is usually a benign and well-tolerated arrhythmia. Most cases of AIVR will require no immediate treatment for this dysrhythmia because AIVR is usually self-limiting and resolves when the sinus rate exceeds that of the ventricular foci. Usually, people with accelerated idioventricular rhythm don’t have any symptoms. If they do, they include:

Fatigue
Dizziness
Passing out
Heart palpitations

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Example of Accelerated Idioventricular Rhythm recorded on Apple Watch ECG. Notice that Apple Watch marked it as Sinus Rhythm

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Example of Accelerated Idioventricular Rhythm recorded on Apple Watch ECG, reviewed by qaly — The same Apple Watch ECG reviewed by QALY team.

Any Cause for Concern?

For most people, accelerated idioventricular rhythm is harmless and goes away without treatment. However, if your heart palpitations don’t stop and you get lightheaded, you may need further evaluation. Other options include medication or procedures to get your heart rhythm back to normal.

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As always, if you show signs of a potential accelerated idioventricular rhythm, contact your healthcare provider as soon as possible to rule out the presence of harmful underlying conditions.

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Still Not Sure How to Spot Accelerated Idioventricular Rhythm on Your Watch ECG?

Your smartwatch can be your partner in looking after your heart. If you’re concerned about accelerated idioventricular rhythm, get your smartwatch ECGs reviewed by experts within minutes on the QALY app: iOS and Android.

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