Written by: Sasha Becker, MD (NUEM ‘27) Edited by: Mara Bezerko (NUEM ‘25) Expert Commentary by: Aaron Wibberley, MD
Expert Commentary
This is a very nice summary by Dr. Becker and Dr. Bezerko of a troublesome-appearing rhythm occasionally encountered in the emergency department. Thankfully, the majority of presentations are benign. Our role as emergency providers is to risk-stratify for, or rule out, dangerous underlying etiologies of AIVR. As pointed out in this post, it is important to keep complete heart block on the differential when caring for patients with slower ventricular rates (examine the rhythm strip closely for dissociated P-waves that are faster than the ventricular rate). As for faster rates, ventricular tachycardia, atrial tachycardias with aberrancy or accessory pathways should be considered. And although less common in the age of having overall wide availability of percutaneous intervention for acute myocardial infarction, it is good for the emergency physician to remember that patients receiving thrombolysis for acute MI in the emergency department can develop this malignant appearing, yet usually self-limited, rhythm. As with many things in emergency medicine, if the patient is stable and appears well, it is prudent to first pause and think critically before implementing an intervention that could risk the patient's well-being.
Aaron Wibberley, MD
Emergency Physician - Northwest Region
Northwestern Medicine
How To Cite This Post:
[Peer-Reviewed, Web Publication] Becker S. Bezerko, M. (2025, Jan 14). AIVR in the ED. [NUEM Blog. Expert Commentary by Wibberley, A]. Retrieved from http://www.nuemblog.com/blog/AIVR
