Table of ContentsView AllTable of ContentsHeart’s Electrical SystemRhythm PatternsWho Gets This Rhythm?Is It Concerning?TreatmentMonitoring
Table of ContentsView All
View All
Table of Contents
Heart’s Electrical System
Rhythm Patterns
Who Gets This Rhythm?
Is It Concerning?
Treatment
Monitoring
Idioventricular rhythmhappens when the heartbeat originates from the heart’s lower chambers at a slower than normal rate. It’s a type ofarrhythmia, meaning the heart rhythm isn’t happening in the normal way.
Idioventricular rhythm may be seen with certain heart conditions that require treatment. In many cases, idioventricular rhythm is temporary, but when it persists it may affect the heart muscle. For this reason, cardiologists (heart specialists) may offer treatment such as medication or procedures.
Understanding the Heart’s Electrical System
The heart tissue has aspecialized conduction systemthat maintains a normal heart rate to pump blood to the body. A normal heart rate at rest is between 60 and 100 beats per minute, but can be faster during times of stress or activity, or slower during sleep.
Normally, the heart’s electrical impulse starts from a bundle of cells called the sinus node, which is located in the heart’s upper right chamber, orright atrium. This stimulates the upper chambers (left and right atria) to contract to pump blood down to the lower chambers (ventricles).
The electrical impulse travels to an area called the atrioventricular (AV) node, located between the upper and lower chambers. Here, it pauses for a moment before traveling down to activate the ventricles to beat. This allows time for the ventricles to fill with blood before pumping it out of the heart.
The sinus node is the heart’s “natural pacemaker” that starts the hearbeat. But when the sinus node fails, there are backup pacemakers in the AV node (responsible forjunctional rhythm) and ventricles that can take over if needed. These can also take over the heart rhythm if they beat faster than the sinus node’s rate. Idioventricular rhythm and accelerated idioventricular rhythm are examples of this—the rhythm originates in the ventricles rather than in the sinus node.
Natural Pacemakers in the HeartThesinus nodeis the heart’s natural pacemaker responsible for starting the electrical signals for the heartbeat. Its typical rate is between 60 and 100 beats per minute (bpm). If the sinus node fails there are backup pacemakers that take over.Cells in theAV nodecan act as a backup pacemaker. These junctional cells normally have a rate of 40 to 60 bpm. A faster than normal rate originating here is known asjunctional tachycardia. This is a type of narrow complex tachycardia, with a narrow QRS in the ECG.Ventricle pacemaker cells have a normal rate between 20 and 40 bpm. A faster rhythm is known asaccelerated idioventricular rhythm. Ventricular rhythms have a wide QRS complex.
Natural Pacemakers in the Heart
Thesinus nodeis the heart’s natural pacemaker responsible for starting the electrical signals for the heartbeat. Its typical rate is between 60 and 100 beats per minute (bpm). If the sinus node fails there are backup pacemakers that take over.Cells in theAV nodecan act as a backup pacemaker. These junctional cells normally have a rate of 40 to 60 bpm. A faster than normal rate originating here is known asjunctional tachycardia. This is a type of narrow complex tachycardia, with a narrow QRS in the ECG.Ventricle pacemaker cells have a normal rate between 20 and 40 bpm. A faster rhythm is known asaccelerated idioventricular rhythm. Ventricular rhythms have a wide QRS complex.
Thesinus nodeis the heart’s natural pacemaker responsible for starting the electrical signals for the heartbeat. Its typical rate is between 60 and 100 beats per minute (bpm). If the sinus node fails there are backup pacemakers that take over.
Cells in theAV nodecan act as a backup pacemaker. These junctional cells normally have a rate of 40 to 60 bpm. A faster than normal rate originating here is known asjunctional tachycardia. This is a type of narrow complex tachycardia, with a narrow QRS in the ECG.
Ventricle pacemaker cells have a normal rate between 20 and 40 bpm. A faster rhythm is known asaccelerated idioventricular rhythm. Ventricular rhythms have a wide QRS complex.
Idioventricular Rhythm ECG Patterns
TheECGrecords electrical impulses and provides information about the heart rate and rhythm. On the ECG, atrial activation appears as a small bump known as the P-wave. Normally, the P-wave is followed a short time later with a narrow spike called the QRS complex. This reflects electrical activation of the ventricles.
In idioventricular rhythm, there are several important differences to note:
Who Gets Idioventricular Rhythm?
Idioventricular rhythm and accelerated idioventricular rhythm are generally associated with underlying heart conditions. These can include:
Electrolyte changes and certain medications, like the heart medication digoxin, can also cause an idioventricular rhythm.
Is Idioventricular Rhythm Benign?
Idioventricular rhythm itself isn’t necessarily dangerous or immediately life-threatening. However, the underlying conditions that may contribute to idioventricular rhythm may require treatment. Acardiologist(heart specialist) is trained in interpreting ECGs and caring for heart problems, and can make a diagnosis and management plan.
Having an idioventricular rhythm when the sinus node has failed means your heart’s backup pacemaker is working properly. However, there is a problem upstream in the conduction system that may need to be addressed.
On the other hand, in accelerated idioventricular rhythm, a faster electrical impulse coming from the ventricle may overtake the sinus node. In that case, the ventricles can still pump blood to the rest of your body adequately. Temporarily having an accelerated idioventricular rhythm is not a problem. If this rhythm persists, which is an uncommon scenario, it can increase the risk of developing heart failure.
When to Treat Idioventricular Rhythm
A cardiologist can help determine whether an idioventricular rhythm needs to be treated. Accelerated idioventricular rhythm is commonly seen after treatment of a heart attack, when blood flow is restored to the heart. This is considered benign (not harmful) and temporary, and does not usually require treatment.
In rare cases, an accelerated idioventricular rhythm may persist and take over the heart’s normal sinus rhythm. It may cause symptoms like light-headedness and fainting, or increase risk of heart failure. Cardiologists may opt to treat this using medication or a minimally invasive procedure known as catheter ablation.
Depending on the underlying cause of the idioventricular rhythm, follow-up with a cardiologist may be needed to manage the heart condition. For example, heart attacks and heart failure require ongoing monitoring and follow-up for management and risk factor control. Even without other known heart problems, a healthcare provider may order imaging tests and heart rhythm monitoring to check how idioventricular rhythm may be affecting your heart.
If you develop concerning symptoms concerning of a heart problem—such as shortness of breath, leg swelling, chest discomfort, palpitations, or fainting—seek medical care to check on your heart.
Summary
If the rhythm persists, treatment with medication or catheter ablation may be provided. A cardiologist or heart specialist can help diagnose and manage heart conditions, including idioventricular rhythm.
7 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.What is an arrhythmia?Hafeez Y, Grossman SA.Junctional rhythm. In:StatPearls. StatPearls Publishing; 2022.American Heart Association.Electrocardiogram (ECG or EKG).Gangwani MK, Nagalli S.Idioventricular Rhythm. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Ljubas Perčić D, Krmek N, Benko I, 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/s12872-023-03074-5Chen M, Gu K, Yang B, et al.Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia.Circ Arrhythm Electrophysiol. 2014;7(6):1159-1167. doi:10.1161/CIRCEP.114.002112Wang L, Liu H, Zhu C, et al.Clinical characteristics and therapeutic strategy of frequent accelerated idioventricular rhythm.BMC Cardiovasc Disord. 2021;21(1):425. doi:10.1186/s12872-021-02221-0
7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Heart Association.What is an arrhythmia?Hafeez Y, Grossman SA.Junctional rhythm. In:StatPearls. StatPearls Publishing; 2022.American Heart Association.Electrocardiogram (ECG or EKG).Gangwani MK, Nagalli S.Idioventricular Rhythm. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Ljubas Perčić D, Krmek N, Benko I, 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/s12872-023-03074-5Chen M, Gu K, Yang B, et al.Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia.Circ Arrhythm Electrophysiol. 2014;7(6):1159-1167. doi:10.1161/CIRCEP.114.002112Wang L, Liu H, Zhu C, et al.Clinical characteristics and therapeutic strategy of frequent accelerated idioventricular rhythm.BMC Cardiovasc Disord. 2021;21(1):425. doi:10.1186/s12872-021-02221-0
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Heart Association.What is an arrhythmia?Hafeez Y, Grossman SA.Junctional rhythm. In:StatPearls. StatPearls Publishing; 2022.American Heart Association.Electrocardiogram (ECG or EKG).Gangwani MK, Nagalli S.Idioventricular Rhythm. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.Ljubas Perčić D, Krmek N, Benko I, 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/s12872-023-03074-5Chen M, Gu K, Yang B, et al.Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia.Circ Arrhythm Electrophysiol. 2014;7(6):1159-1167. doi:10.1161/CIRCEP.114.002112Wang L, Liu H, Zhu C, et al.Clinical characteristics and therapeutic strategy of frequent accelerated idioventricular rhythm.BMC Cardiovasc Disord. 2021;21(1):425. doi:10.1186/s12872-021-02221-0
American Heart Association.What is an arrhythmia?
Hafeez Y, Grossman SA.Junctional rhythm. In:StatPearls. StatPearls Publishing; 2022.
American Heart Association.Electrocardiogram (ECG or EKG).
Gangwani MK, Nagalli S.Idioventricular Rhythm. [Updated 2023 Jul 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.
Ljubas Perčić D, Krmek N, Benko I, 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
Chen M, Gu K, Yang B, et al.Idiopathic accelerated idioventricular rhythm or ventricular tachycardia originating from the right bundle branch: unusual type of ventricular arrhythmia.Circ Arrhythm Electrophysiol. 2014;7(6):1159-1167. doi:10.1161/CIRCEP.114.002112
Wang L, Liu H, Zhu C, et al.Clinical characteristics and therapeutic strategy of frequent accelerated idioventricular rhythm.BMC Cardiovasc Disord. 2021;21(1):425. doi:10.1186/s12872-021-02221-0
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