accelerated idioventricular rhythm: not always a reperfusion arrhythmia

Accelerated idioventricular rhythm (aivr) is a relatively slow ventricular rhythm that often occurs during the reperfusion phase of an acute myocardial infarction. it is generally considered a benign rhythm that does not require treatment. however, we present a case where aivr was the presenting arrhythmia in a 41-year-old man with acute coronary syndrome, suggesting it might not be as benign as previously reported in the literature. the patient, who presented to our institute, underwent urgent coronary evaluation followed by revascularization, leading to the conversion of aivr to normal sinus rhythm and improvement in anginal symptoms.