Accelerated Idioventricular Rhythm

View Rhythm Strip
Transcutaneous PacingStep-by-step setup, capture & troubleshooting
TC Pacing — Quick Steps
Full guide →
  1. Apply pads anterior–posterior; attach ECG leads from the pacer/monitor.
  2. Pre-medicate for discomfort: midazolam ± fentanyl if BP allows.
  3. Set mode Demand (synchronous), rate 60–80/min.
  4. Increase output (mA) by 5–10 until electrical capture (wide QRS after each spike).
  5. Confirm mechanical capture: palpate femoral/right brachial pulse (not carotid).
  6. Set final output ~10 mA above threshold; reassess BP, perfusion, mentation.
  7. Bridge to transvenous pacing or treat underlying cause.
ANTERIORANTPOSTERIORPOSTSandwich the heart between pads
A–P pad placement

Rhythm strip

Source ↗
Wide QRSRate 50–110No preceding P waves
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Tap a label on the strip to highlight the matching feature below.

  • Wide QRS, regular rhythm
  • Rate 50–110 (faster than escape, slower than VT)
  • Often after reperfusion (post-thrombolysis / PCI)
Recognition
  • Wide QRS, regular rhythm
  • Rate 50–110 (faster than ventricular escape, slower than VT)
  • Often seen after successful thrombolysis or PCI
Management
Usually no treatment
  • — may be the only perfusing rhythm

Educational reference only. Always follow current ACLS guidelines and institutional protocols.