Inferior infarction, reperfusion and AIVR

Patient

69-year-old man, smoker, referred by emergency services for an inferior infarction at H+1; initiation of fibrinolysis in the ambulance; on arrival in the department there is cessation of chest pain;

Trace

Probable AIVR (accelerated idioventricular rhythm); ventricular rhythm with wide QRS at 80 bpm; probable retrograde atrial conduction; a P-wave is identifiable on the tracing, followed by a fusion complex; tall ST-elevation in the inferior territory and from V5 to V6; marked ST-depression from V1 to V3;

Trace

Tracing recorded simultaneously with the right and posterior leads; during this tracing, the occurrence of a ventricular extrasystole interrupting the AIVR with return of sinus rhythm and appearance of ST-elevation in the inferior territory and in the posterior territory;

Trace

Tracing recorded the next day; left axis with no significant Q-wave in the inferior territory; negative T-waves in leads III, aVF;

Exergue

An AIVR can occur during reperfusion of an inferoposterior myocardial infarction in a setting of sinus bradycardia. While it has limited prognostic meaning, it is indicative of an effective reperfusion if it is accompanied by resolution of pain and a decrease in elevation.