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Cardiology428 papers

Idioventricular rhythm

Last edited: 4/23/2026

Overview

Idioventricular rhythm, also known as ventricular escape rhythm, occurs when the ventricles generate impulses independently due to the absence of normal sinus node or atrioventricular (AV) conduction. It typically manifests as a slow heart rate (usually 20-40 bpm) with a wide QRS complex, reflecting intrinsic ventricular depolarization 12318.

Diagnosis

  • Clinical Presentation: Slow heart rate, often symptomatic with fatigue, dizziness, or syncope 13.
  • Electrocardiogram (ECG) Findings: Wide QRS complex, absence of P waves, and regular rhythm 1318.
  • Echocardiography: Useful to assess ventricular function and rule out structural heart disease 13.
  • Electrophysiological Studies: Rarely needed but can confirm absence of supraventricular impulse capture 13.
  • Management

  • Underlying Cause Correction: Address and treat any reversible causes such as electrolyte imbalances, drug toxicity, or ischemia 13.
  • Temporary Pacing: Indicated for symptomatic bradycardia or hemodynamic instability 13.
  • Permanent Pacing: Consider for persistent idioventricular rhythm with symptoms or risk of hemodynamic compromise 131619.
  • Physiological Pacing Sites: Left bundle branch area pacing (LBBAP) or His bundle pacing preferred to improve cardiac function and reduce dyssynchrony 3151621.
  • Special Populations

  • Pediatrics: Limited data; pacing strategies should consider growth and development, with careful lead placement 2246.
  • Elderly: Focus on minimizing complications and ensuring appropriate device programming to avoid oversensing and inappropriate shocks 4445.
  • Comorbidities: Tailor management to coexisting conditions like heart failure or frailty, emphasizing physiological pacing to preserve cardiac function 3449.
  • Key Recommendations

  • Identify and Correct Underlying Causes: Address reversible causes such as electrolyte disturbances or medication side effects (Evidence: Strong 13).
  • Temporary Pacing for Symptomatic Patients: Use temporary pacing in cases of hemodynamic instability or severe symptoms (Evidence: Moderate 13).
  • Consider Permanent Pacing for Persistent Symptoms: Implement permanent pacing in patients with persistent idioventricular rhythm and significant symptoms or hemodynamic risk (Evidence: Moderate 1316).
  • Prefer Physiological Pacing Sites: Opt for LBBAP or His bundle pacing to enhance cardiac efficiency and reduce dyssynchrony (Evidence: Moderate 3151621).
  • Monitor and Manage Comorbidities: Tailor pacing strategy to coexisting conditions like heart failure or frailty to optimize outcomes (Evidence: Expert opinion 3449).
  • References

    Showing 100 most recent of 223 indexed papers.

    1 Qiu Z, Wu X, Hu W, Tang Y, Xu Z, Ou Z et al.. Interatrial Synchronized Pacing at the Posterosuperior Bundle: Feasibility, Mechanism, and Mid-Term Outcomes. Circulation. Arrhythmia and electrophysiology 2026. link 2 Yang S, Zhang H, Sheng G, Chen Y, Yu X, Gong C et al.. Efficacy Comparison Between Conventional and Probe Methods for Left Bundle Branch Area Pacing. Journal of cardiovascular electrophysiology 2026. link 3 Glikson M, Burri H, Abdin A, Cano O, Curila K, De Pooter J et al.. European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2025. link 4 Korf HW. Photoneuroendocrine, circadian and seasonal systems: from photoneuroendocrinology to circadian biology and medicine. Cell and tissue research 2025. link 5 Ferns SJ, Vaseghi M, Singleton MJ, Nguyen DT, Narayan SM, Bilchick KC. Factors of engagement in research after graduation from EP fellowship: An HRS survey. Heart rhythm 2025. link 6 Jiménez-López J, González-Matos CE, Rodriguez-Queraltó O, Francisco-Pascual J, Lal-Trehan Estrada N, Martín-Sánchez G et al.. Pacing system analyzers to guide conduction system pacing implantation procedures: A comparison study of intracardiac and surface signals with an electrophysiology recording system. Heart rhythm 2025. link 7 Shen J, Jiang L, Wu H, Zhang L, Li H, Pan L. Electrophysiological characteristics of lead position-dependent electrogram uninterrupted transition during left bundle branch pacing. Heart rhythm 2025. link 8 Damera MC, Centanni R, Sherman A, Kline J, Follansbee CW, Chang PM et al.. Evaluating the diagnostic accuracy of reduced lead paediatric electrocardiograms. Cardiology in the young 2025. link 9 Parlavecchio A, Vetta G, Coluccia G, Pistelli L, Caminiti R, Crea P et al.. Success and complication rates of conduction system pacing: a meta-analytical observational comparison of left bundle branch area pacing and His bundle pacing. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2024. link 10 Weiss JP, Farb A. Early feasibility studies in the United States: Focus on electrophysiology. Journal of cardiovascular electrophysiology 2023. link 11 Pombo Jiménez M, Chimeno García J, Bertomeu González V, Cano Pérez Ó. Spanish pacemaker registry. 19th official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2021). Revista espanola de cardiologia (English ed.) 2022. link 12 Cornelissen G. Applications of cosinor rhythmometry in pharmacology. Journal of pharmacokinetics and pharmacodynamics 2021. link 13 Pombo Jiménez M, Chimeno García J, Bertomeu-González V, Cano Pérez Ó. Spanish Pacemaker Registry. 18th Official Report of the Cardiac Pacing Section of the Spanish Society of Cardiology (2020). Revista espanola de cardiologia (English ed.) 2021. link 14 Auricchio A, Conte G, Demarchi A, Baldi E, Özkartal T, Regoli F et al.. Challenges in activation of remote monitoring in patients with cardiac rhythm devices during the coronavirus (COVID-19) pandemic. International journal of cardiology 2021. link 15 Zhang J, Wang Z, Zu L, Cheng L, Su R, Wang X et al.. Simplifying Physiological Left Bundle Branch Area Pacing Using a New Nine-Partition Method. The Canadian journal of cardiology 2021. link 16 Bakelants E, Zweerink A, Burri H. Programming and follow-up of patients with His bundle pacing. Herzschrittmachertherapie & Elektrophysiologie 2020. link 17 Albatat M, Bergsland J, Arevalo H, Odland HH, Bose P, Halvorsen PS et al.. Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices. Annals of biomedical engineering 2020. link 18 Su L, Xu T, Cai M, Xu L, Vijayaraman P, Sharma PS et al.. Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing. Journal of cardiovascular electrophysiology 2020. link 19 Cano Pérez Ó, Pombo Jiménez M, Lorente Carreño D, Chimeno García J. Spanish Pacemaker Registry. 16th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2018). Revista espanola de cardiologia (English ed.) 2019. link 20 Revishvili A, Babak A, Didenko M. Overview of the current electrophysiology (EP) state of affairs in Russia. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2019. link 21 Ezzeddine FM, Dandamudi G. Updates on His bundle pacing: The road more traveled lately. Trends in cardiovascular medicine 2019. link 22 Bonelli F, Vezzosi T, Meylan M, Nocera I, Ferrulli V, Buralli C et al.. Comparison of smartphone-based and standard base-apex electrocardiography in healthy dairy cows. Journal of veterinary internal medicine 2019. link 23 Starr N, Dayal N, Domenichini G, Stettler C, Burri H. Electrical parameters with His-bundle pacing: Considerations for automated programming. Heart rhythm 2019. link 24 Burri H, Keene D, Whinnett Z, Zanon F, Vijayaraman P. Device Programming for His Bundle Pacing. Circulation. Arrhythmia and electrophysiology 2019. link 25 Della Rocca DG, Gianni C, Di Biase L, Natale A, Al-Ahmad A. Leadless Pacemakers: State of the Art and Future Perspectives. Cardiac electrophysiology clinics 2018. link 26 Lee JZ, Mulpuru SK, Shen WK. Leadless pacemaker: Performance and complications. Trends in cardiovascular medicine 2018. link 27 Zucchelli G, Barletta V, Bongiorni MG. Leadless technology: a new paradigm for cardiac pacing?. Minerva cardioangiologica 2018. link 28 Yoshinaga M, Iwamoto M, Horigome H, Sumitomo N, Ushinohama H, Izumida N et al.. Standard Values and Characteristics of Electrocardiographic Findings in Children and Adolescents. Circulation journal : official journal of the Japanese Circulation Society 2018. link 29 Mlynarska A, Mlynarski R, Golba KS. Anxiety, age, education and activities of daily living as predictive factors of the occurrence of frailty syndrome in patients with heart rhythm disorders. Aging & mental health 2018. link 30 Bhatt AG, Musat DL, Milstein N, Pimienta J, Flynn L, Sichrovsky T et al.. The Efficacy of His Bundle Pacing: Lessons Learned From Implementation for the First Time at an Experienced Electrophysiology Center. JACC. Clinical electrophysiology 2018. link 31 Cano Pérez Ó, Pombo Jiménez M, Fidalgo Andrés ML, Lorente Carreño D, Coma Samartín R. Spanish Pacemaker Registry. 14th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2016). Revista espanola de cardiologia (English ed.) 2017. link 32 Rakhshan M, Ansari L, Molazem Z, Zare N. Complications of Heart Rhythm Management Devices After Cardiac Rehabilitation Program. Clinical nurse specialist CNS 2017. link 33 Groeneveld PW, Dixit S. Cardiac Pacing and Defibrillation Devices: Cost and Effectiveness. Annual review of medicine 2017. link 34 Mlynarska A, Mlynarski R, Golba KS. Frailty syndrome in patients with heart rhythm disorders. Geriatrics & gerontology international 2017. link 35 Fauchier L, Alonso C, Anselme F, Blangy H, Bordachar P, Boveda S et al.. Position paper for management of elderly patients with pacemakers and implantable cardiac defibrillators: Groupe de Rythmologie et Stimulation Cardiaque de la Société Française de Cardiologie and Société Française de Gériatrie et Gérontologie. Archives of cardiovascular diseases 2016. link 36 Cohen M, Sanatani S, Stephenson E, Skinner J, Drago F, Davis A et al.. Pediatric & Congenital Electrophysiology Society: building an international paediatric electrophysiology organisation. Heart rhythm 2016. link 37 Austin C, Kusumoto F. Innovative pacing: Recent advances, emerging technologies, and future directions in cardiac pacing. Trends in cardiovascular medicine 2016. link 38 Lau DH, Volders PG, Kohl P, Prinzen FW, Zaza A, Kääb S et al.. Opportunities and challenges of current electrophysiology research: a plea to establish 'translational electrophysiology' curricula. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2015. link 39 Cano Pérez Ó, Pombo Jiménez M, Coma Samartín R. Spanish Pacemaker Registry. Twelfth Official Report of the Spanish Society of Cardiology Working Group on Cardiac Pacing (2014). Revista espanola de cardiologia (English ed.) 2015. link 40 Shah AJ, Lim HS, Yamashita S, Zellerhoff S, Berte B, Mahida S et al.. Noninvasive mapping of ventricular arrhythmias. Cardiac electrophysiology clinics 2015. link 41 Pang BJ, Kumar S, Tacey MA, Mond HG. Capturing the His-Purkinje system is not possible from conventional right ventricular apical and nonapical pacing sites. Pacing and clinical electrophysiology : PACE 2014. link 42 Janoušek J, Kubuš P. What's new in cardiac pacing in children?. Current opinion in cardiology 2014. link 43 Chen KP, Xu G, Wu S, Tang B, Wang L, Zhang S. Clinical evaluation of pacemaker automatic capture management and atrioventricular interval extension algorithm. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2013. link 44 Chiladakis JA, Kalogeropoulos A, Zagkli F, Koutsogiannis N, Chouchoulis K, Alexopoulos D. Facilitating assessment of QT interval duration during ventricular pacing. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2013. link 45 Deo R, Nalls MA, Avery CL, Smith JG, Evans DS, Keller MF et al.. Common genetic variation near the connexin-43 gene is associated with resting heart rate in African Americans: a genome-wide association study of 13,372 participants. Heart rhythm 2013. link 46 Czosek RJ, Meganathan K, Anderson JB, Knilans TK, Marino BS, Heaton PC. Cardiac rhythm devices in the pediatric population: utilization and complications. Heart rhythm 2012. link 47 Khaja A, Govindarajan G, McDaniel W, Flaker G. Cardiac safety of conducted electrical devices in pigs and their effect on pacemaker function. The American journal of emergency medicine 2011. link 48 Harding ME, Palma EC. Transvenous dual site left ventricular pacing to lower elevated pacing thresholds. Pacing and clinical electrophysiology : PACE 2011. link 49 Sabelli H, Messer J, Kovacevic L, Walthall K. The biotic pattern of heartbeat intervals. International journal of cardiology 2010. link 50 Lau CP, Siu CW. Pacing technology: advances in pacing threshold management. Journal of Zhejiang University. Science. B 2010. link 51 Schnorr B, Kelsch B, Cremers B, Clever YP, Speck U, Scheller B. Contemporary issues in cardiac pacing. Minerva cardioangiologica 2010. link 52 Proclemer A, Ghidina M, Gregori D, Facchin D, Rebellato L, Zakja E et al.. Trend of the main clinical characteristics and pacing modality in patients treated by pacemaker: data from the Italian Pacemaker Registry for the quinquennium 2003-07. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology 2010. link 53 Erdogan O, Hunuk B. Right ventricular outflow tract pacing: an alternative, safe, and effective pacing site. Journal of long-term effects of medical implants 2010. link 54 Stampfer HG, Hood SD. Circadian rhythms: keeping pace with developments. The Medical journal of Australia 2009. link 55 Carvajal A, Macías D, Salado I, Sáinz M, Ortega S, Campo C et al.. Heart rhythm disturbances associated with rupatadine: a case series from the Spanish and Portuguese pharmacovigilance systems. 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Physiologic pacing: new modalities and pacing sites. Pacing and clinical electrophysiology : PACE 2006. link 68 Saksena S. Achieving global access to heart rhythm therapies in the next decade: a tangible goal. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing 2006. link 69 Tu C, Zeng Y, Yang X. A new approach to detect QRS complexes based on a histogram and genetic algorithm. Journal of medical engineering & technology 2005. link 70 Yee R, Klein GJ, Krahn AC, Skanes AC. Selective site pacing: tools and training. Pacing and clinical electrophysiology : PACE 2004. link 71 Soylu M, Ozdemir O, Geyik B, Ozbakir C, Demir AD, Duru E et al.. Evaluation of the early hemodynamic changes in carotid arteries during ventricular and dual chamber pacing. Pacing and clinical electrophysiology : PACE 2004. link 72 Cooper HE, Clutton-Brock TH, Parkes MJ. Contribution of the respiratory rhythm to sinus arrhythmia in normal unanesthetized subjects during positive-pressure mechanical hyperventilation. American journal of physiology. Heart and circulatory physiology 2004. link 73 McCoy F. More than a device: today's medical technology companies provide value through service. Cardiac electrophysiology review 2003. link 74 Lüderitz B. History of cardiac rhythm disorders. Zeitschrift fur Kardiologie 2002. link 75 Sun Y, Chan K, Krishnan SM. ECG signal conditioning by morphological filtering. Computers in biology and medicine 2002. link00034-3) 76 Krupa W, Kozłowski D, Derejko P, Swiatecka G. Permanent cardiac pacing and its influence on tricuspid valve function. Folia morphologica 2001. link 77 Folarin VA, Fitzsimmons PJ, Kruyer WB. Holter monitor findings in asymptomatic male military aviators without structural heart disease. Aviation, space, and environmental medicine 2001. link 78 Boudet G, Chamoux A. 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    Original source

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      Interatrial Synchronized Pacing at the Posterosuperior Bundle: Feasibility, Mechanism, and Mid-Term Outcomes.Qiu Z, Wu X, Hu W, Tang Y, Xu Z, Ou Z et al. Circulation. Arrhythmia and electrophysiology (2026)
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      Efficacy Comparison Between Conventional and Probe Methods for Left Bundle Branch Area Pacing.Yang S, Zhang H, Sheng G, Chen Y, Yu X, Gong C et al. Journal of cardiovascular electrophysiology (2026)
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      European Society of Cardiology (ESC) clinical consensus statement on indications for conduction system pacing, with special contribution of the European Heart Rhythm Association of the ESC and endorsed by the Asia Pacific Heart Rhythm Society, the Canadian Heart Rhythm Society, the Heart Rhythm Society, and the Latin American Heart Rhythm Society.Glikson M, Burri H, Abdin A, Cano O, Curila K, De Pooter J et al. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (2025)
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      Factors of engagement in research after graduation from EP fellowship: An HRS survey.Ferns SJ, Vaseghi M, Singleton MJ, Nguyen DT, Narayan SM, Bilchick KC Heart rhythm (2025)
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      Pacing system analyzers to guide conduction system pacing implantation procedures: A comparison study of intracardiac and surface signals with an electrophysiology recording system.Jiménez-López J, González-Matos CE, Rodriguez-Queraltó O, Francisco-Pascual J, Lal-Trehan Estrada N, Martín-Sánchez G et al. Heart rhythm (2025)
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      Success and complication rates of conduction system pacing: a meta-analytical observational comparison of left bundle branch area pacing and His bundle pacing.Parlavecchio A, Vetta G, Coluccia G, Pistelli L, Caminiti R, Crea P et al. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing (2024)
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