Frequency of Accelerated Idioventricular Rhythm in Patients Receiving Thrombolytic Treatment for ST-Segment Elevation Myocardial Infarction
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Background: Accelerated idioventricular rhythm is commonly regarded as a transient ventricular rhythm associated with the reperfusion phase of acute myocardial infarction and is often interpreted as a clinical marker of successful thrombolysis. In settings where fibrinolytic therapy remains widely used for ST-segment elevation myocardial infarction, locally generated evidence regarding the frequency of accelerated idioventricular rhythm is limited. Objective: To determine the frequency of accelerated idioventricular rhythm in patients receiving thrombolytic treatment for ST-segment elevation myocardial infarction and to examine its distribution across selected demographic and clinical characteristics. Methods: This descriptive observational study was conducted at the Department of Cardiology, Bolan Medical College/Hospital, Quetta, from 11 January 2025 to 12 October 2025. Using non-probability consecutive sampling, 196 patients aged 18 to 75 years with ST-segment elevation myocardial infarction treated with streptokinase were enrolled. Patients were monitored for 24 hours during and after thrombolytic infusion, and accelerated idioventricular rhythm was recorded on electrocardiographic assessment. Data were analyzed using SPSS version 23.0. Frequencies, percentages, means, and standard deviations were computed, and chi-square testing was used for exploratory subgroup comparisons. Results: The mean age was 51.05 ± 6.76 years and the mean body mass index was 25.09 ± 4.17 kg/m². Accelerated idioventricular rhythm occurred in 80 of 196 patients, giving an overall frequency of 40.8%. Statistically significant exploratory associations were observed with hypertension (p=0.05), hyperlipidemia (p=0.001), education status (p=0.02), and residence (p=0.001), whereas age, sex, body mass index, smoking status, and diabetes mellitus were not significantly associated. Conclusion: Accelerated idioventricular rhythm was a frequent early arrhythmic finding after streptokinase thrombolysis in patients with ST-segment elevation myocardial infarction. Although several subgroup differences were observed, these findings were exploratory and require confirmation in analytically robust studies.
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