Cocaine induced Accelerated Idioventricular Rhythm (AIVR)

Title : Cocaine induced Accelerated Idioventricular Rhythm (AIVR)

Abstract:

Introduction: Cocaine-induced cardiotoxicity is a well-recognized phenomenon associated with a broad spectrum of cardiovascular complications, including arrhythmias. We present a case of a 26-year-old male with a history of mitral valve prolapse (MVP) who developed accelerated idioventricular rhythm (AIVR) in the setting of recent cocaine use, stimulant exposure, and binge alcohol consumption.

Case Presentation: The patient presented with palpitations, lightheadedness, and chest discomfort. Initial evaluation revealed sinus tachycardia and a wide-complex rhythm consistent with AIVR on electrocardiogram. Laboratory workup, including electrolytes and cardiac biomarkers, was unremarkable, and imaging with transthoracic echocardiography demonstrated preserved left ventricular function with mild mitral regurgitation related to MVP. Toxicology screening was positive for cocaine. The patient was admitted for cardiac monitoring, during which intermittent episodes of AIVR were observed, occasionally associated with bradycardia. Despite these findings, he remained hemodynamically stable throughout hospitalization.

Management was primarily supportive. Beta-blockers were avoided due to the risk of unopposed alpha-adrenergic stimulation in the context of cocaine use. The arrhythmia resolved spontaneously, and the patient was discharged with plans for outpatient Holter monitoring and cardiac MRI. Follow-up imaging revealed no structural abnormalities, myocardial inflammation, or fibrosis.

Disccusion: Cocaine exerts its cardiotoxic effects through multiple mechanisms, including inhibition of catecholamine reuptake, sodium channel blockade, and coronary vasoconstriction. These effects increase myocardial oxygen demand, disrupt electrical conduction, and predispose patients to a range of arrhythmias. While AIVR is typically considered a benign and transient rhythm, its occurrence in the setting of cocaine use highlights underlying myocardial irritability and necessitates careful evaluation.

This case underscores the importance of distinguishing cocaine-induced AIVR from more malignant ventricular arrhythmias such as ventricular tachycardia, as management strategies differ significantly. Recognition of this presentation can help avoid unnecessary interventions and guide appropriate supportive care. Early identification and counseling on substance use are critical to preventing recurrent cardiac events.

Biography:

Faizan Butt, MD is a PGY-2 Internal Medicine Resident at Rutgers Jersey City Medical Center with focused interest in cardiovascular medicine. His clinical and academic interests include advanced heart failure, mechanical circulatory support, cardiogenic shock and complex coronary interventions. He is actively engaged in quality improvement and outcomes-based research initiatives aimed at optimizing guideline-directed medical therapy and improving cardiovascular risk stratification. he have led and collaborated on IRB-approved projects and multidisciplinary efforts designed to enhance inpatient and transitional cardiac care With a strong foundation in hemodynamic assessment and devise-based therapies, he committed to integrating evidence-based medicine with innovative clinical practice. he have plans to pursue fellowship training in cardiovascular disease and aspires to contribute to academic cardiology through research, education and leadership focus on improving patient centered cardiovascular outcomes.