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A 63-year-old woman undergoing elective total knee replacement developed AIVR during induction with desflurane when end-tidal concentration increased. The dysrhythmia resolved after discontinuation but recurred upon desflurane restart, persisted after switching to sevoflurane with decreasing frequency, and was managed while continuing surgery. Postoperative markers and recovery were unremarkable, returning to normal sinus rhythm within about 20 minutes.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/accelerated-idioventricular-rhythm-associated-with-desflurane-anesthesia-a-case-report/156458/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/accelerated-idioventricular-rhythm-associated-with-desflurane-anesthesia-a-case-report/156458.png","ImageObject",300,407,{"name":92,"@type":93},"Terk","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-08","2026-08-28",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",13,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"How is accelerated idioventricular rhythm (AIVR) defined and differentiated in this report?","Question",{"text":113,"@type":114},"AIVR is defined as a ventricular rhythm of 60–100 beats per minute or slow ventricular tachycardia, and it should be differentiated from other ventricular tachycardias/AIVR of different origins. The report outlines potential causes such as ischemic heart disease and digitalis intoxication to emphasize differentiation.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What triggered AIVR during anesthesia in the presented patient?",{"text":118,"@type":114},"AIVR appeared when the end-tidal concentration of desflurane was increased, accompanied by an abnormal EKG with a wide QRS complex. The rhythm improved after stopping desflurane and recurred when desflurane was restarted, supporting desflurane as the cause.",{"name":120,"@type":111,"acceptedAnswer":121},"What was the management approach and how did the outcome turn out?",{"text":122,"@type":114},"Lidocaine was administered while monitoring, then desflurane was stopped and sevoflurane was used when the rhythm continued. The AIVR frequency decreased, surgery proceeded, and the patient recovered normal sinus rhythm within about 20 minutes with normal postoperative EKG and cardiac markers.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},156458,1787959315,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":81,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":130,"read_time":39},1099525198933,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Korean J Anesthesiol 2009 May; 56(5): 571-3 DOI: 10.4097/kjae.2009.56.5.571  \n□ Case  \nReport □  \nAccelerated idioventricular rhythm associated with desflurane anesthesia  \n− A case report −  \nDepartment of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea  \nJiyoun Bang, Jun-Gol Song, Young-Soo Park, and Hong-Seuk Yang  \nAccelerated idioventricular rhythm is defined as a ventricular rhythm of 60-100 beats per minute or a ventricular tachycardia that does nor exceed 120 beats per minutes. Although, it rarely converts to a fatal arrhythmia like ventricular fibrillation, it needs to be differentiated from AIVR, which is from another origin. AIVR may occur due to ischemic heart disease (ST elevated myocardial infarction), cardiomyopathy, rheumatic fever and digitalis intoxication. We report here on a case of AIVR that was related to desflurane administration. (Korean J Anesthesiol 2009; 56: 571～3)  \nKey Words: Accelerated idioventricular rhythm, Arrhythmia, Desflurane, Sevoflurane.  \nThe term of accelerated idioventricular rhythm (AIVR) or slow ventricular tachycardia describes an ectopic ventricular rhythm with 3 or more consecutive ventricular premature beats with a rate faster than the normal ventricular intrinsic escape rate of 30 to 40 beats per minute, but slower than ventricular tachycardia [1] . Although AIVR has been reported in patients during administration of inhaled anesthetic, desflurane, it is converted to normal sinus rhythm after stopping administration of desflurane [2] . We described here a patient who experienced AIVR during the induction of anesthesia for the total knee replacement arthroplasty (TKRA) in the right knee that persisted after change of anesthetic from desflurane to sevoflurane.  \nCASE REPORT  \nA 63-year-old woman (weight 77 kg, height 165 cm) was scheduled for elective TKRA owing to osteoarthritis in her right knee. At her preoperative visit, she reported no history of cardiovascular disease and routine preoperative laboratory test (blood cell count, hemoglobin, coagulation test, serum glucose,  \nReceived: October 9, 2008.  \nAccepted: December 31, 2008.  \nCorresponding author: Hong-Seuk Yang, M.D., Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, 388-1, Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea. Tel: 82-2-  \n3010-3865, Fax: 82-2-470-1363, E-mail: [hsyang@amc.seoul.kr](hsyang@amc.seoul.kr)[ ](hsyang@amc.seoul.kr)Copyright ⓒ Korean Society of Anesthesiologists, 2009  \nnitrogen, creatine, electrolyte, bilirubin, aspartic acid transaminase (AST), alanine transaminase (ALT), creatine kinase, lactate dehydrogenase, cholinesterase, and urine analysis) were within normal range.  \nThe patient had previously undergone two operations for excision of varicose veins in her lower legs; both operations ended without complications. Her vital signs at the admission were stable (blood pressure 134 − 120/89−83 mmHg, pulse rate 54 bpm, body temperature 36.9oC) . Her preoperative ECG showed first degree AV block (Fig. 1). Echocardiogram showed normal systolic function (EF 63%) and no structural or functional abnormalities. A thallium scan showed that perfusion of the myocardium was normal. She received no premedication. On arrival in the operating room, her blood pressure was 140/80 mmHg and pulse rate was 75 bpm. Thiopental sodium 300 mg was administered to induce unconsciousness and rocuronium 40 mg was injected. Mask ventilation was performed with desflurane and nitrous oxide (N2O) . As the end tidal concentration of desflurane approached to 5.2 vol%, an abnormal EKG wave was observed at a rate of 60−80 bpm for 10 sec accompanied by a wide QRS complex (Fig. 2) at 5-10-second intervals. Despite administration of lidocaine 100 mg, the ar-  \nFig. 1. Normal preoperative ECG (lead II) .  \nVol. 56, No. 5, May 2009  \nFig. 2. AIVR that appeared when the desflurane concentration was increased (lead I","cbCaiavSQPDBy8Wb","https://ap.wps.com/l/cbCaiavSQPDBy8Wb","pdf",955208,"English","# Case Report\n## Definition and background of AIVR\n## Patient evaluation and anesthesia course\n## Arrhythmia recognition and management\n## Postoperative assessment and outcome","[{\"question\":\"How is accelerated idioventricular rhythm (AIVR) defined and differentiated in this report?\",\"answer\":\"AIVR is defined as a ventricular rhythm of 60–100 beats per minute or slow ventricular tachycardia, and it should be differentiated from other ventricular tachycardias/AIVR of different origins. The report outlines potential causes such as ischemic heart disease and digitalis intoxication to emphasize differentiation.\"},{\"question\":\"What triggered AIVR during anesthesia in the presented patient?\",\"answer\":\"AIVR appeared when the end-tidal concentration of desflurane was increased, accompanied by an abnormal EKG with a wide QRS complex. The rhythm improved after stopping desflurane and recurred when desflurane was restarted, supporting desflurane as the cause.\"},{\"question\":\"What was the management approach and how did the outcome turn out?\",\"answer\":\"Lidocaine was administered while monitoring, then desflurane was stopped and sevoflurane was used when the rhythm continued. The AIVR frequency decreased, surgery proceeded, and the patient recovered normal sinus rhythm within about 20 minutes with normal postoperative EKG and cardiac markers.\"}]","Accelerated Idioventricular Rhythm Associated with Desflurane Anesthesia - A Case Report | PDF"]