Two hours after successful primary PCI for an anterior STEMI, a 59-year-old man develops wide QRS complexes at a rate of 78/min with AV dissociation on telemetry. He is asymptomatic with blood pressure 118/72 mmHg. What is the most appropriate management?
- A Immediate synchronized cardioversion
- B Observation alone, as this rhythm is self-limiting ✓
- C Intravenous amiodarone infusion
- D Temporary transvenous pacemaker insertion
Correct answer: B. Observation alone, as this rhythm is self-limiting
Explanation
Accelerated idioventricular rhythm, a ventricular rate between 40 and 100 with AV dissociation, commonly follows successful reperfusion and is called a reperfusion arrhythmia. It is hemodynamically well tolerated, self-limiting, and requires no treatment; suppressing it may worsen hemodynamics. Cardioversion and amiodarone are reserved for sustained VT causing instability. Pacing addresses bradyarrhythmias with rates below 40 or high-grade AV block, neither of which is present here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.