Accelerated idioventricular rhythm detected during elective surgery in a healthy man

Accelerated idioventricular rhythm (AIVR) is found most commonly in the presence of underlying heart disease. It is characterized by acceleration of a latent pacemaker that normally depolarizes slowly. We describe a 30‐year‐old man who was found to have episodes of accelerated idioventricular rhythm (AIVR) on cardiac monitoring during elective orthopedic surgery. Noninvasive evaluation including two‐dimensional echocardiography was unremarkable. No late potentials were detected on a signal‐averaged electrocardiogram. During an exercise tolerance test, AIVR was suppressed as heart rate increased. A 24‐h Holter monitor revealed that the AIVR rate was consistently 73‐76 beats/min, which appeared whenever the sinus rate slowed to this level. The patient has been asymptomatic, and the rhythm has persisted at least through a 5‐month follow‐up period.