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Accelerated Idioventricular Rhythm

Notice that there are no P-waves seen here, that the QRS duration, though not precisely demarcated, is about 0.16 seconds, and that the depolarization phase slurs into the repolarization phase, which is opposite the baseline in every lead.  This, then, is a ventricular rhythm.  The rate is 74, so this is neither ventricular tachycardia nor is it idioventricular rhythm.  It is called accelerated idioventricular rhythm.  Brief, self-limiting runs of this rhythm may occur in acute MI, when an ectopic ventricular pacemaker accelerates and asserts control over the heart.  Sustained AIVR may occur when an existing idioventricular rhythm accelerates.   That is the case here:  a very sick heart is attempting to provide perfusion.