Accelerated idioventricular rhythm (AIVR) is often transient, considered benign and requires no treatment. This observational study aims to investigate the clinical manifestations, treatment, and prognosis of frequent AIVR. Twenty-seven patients (20 male; mean age 32.2 ± 17.0 years) diagnosed with frequent AIVR were enrolled in our study. Inclusion criteria were as follows: (1) at least three recordings of AIVR on 24-h Holter monitoring with an interval of over one month between each recording; and (2) resting ectopic ventricular rate between 50 to 110 bpm on ECG. Electrophysiological study (EPS) and catheter ablation were performed in patients with distinct indications. All 27 patients experienced palpitation or chest discomfort, and two had syncope or presyncope on exertion. Impaired left ventricular ejection fraction (LVEF) was identified in 5 patients, and LVEF was negatively correlated with AIVR burden (P < 0.001). AIVR burden of over 73.8%/day could predict impaired LVEF with a sensitivity of 100% and specificity of 94.1%. Seventeen patients received EPS and ablation, five of whom had decreased LVEF. During a median follow-up of 60 (32, 84) months, LVEF of patients with impaired LV function returned to normal levels 6 months post-discharge, except one with dilated cardiomyopathy (DCM). Two patients died during follow-up. The DCM patient died due to late stage of heart failure, and another patient who refused ablation died of AIVR over-acceleration under fever. Frequent AIVR has unique clinical manifestations. AIVR patients with burden of over 70%, impaired LVEF, and/or symptoms of syncope or presyncope due to over-response to sympathetic tone should be considered for catheter ablation.

中文翻译：

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频发加速性室性心律的临床特点及治疗策略

加速性室性心律 (AIVR) 通常是短暂的，被认为是良性的，不需要治疗。这项观察性研究旨在调查频繁 AIVR 的临床表现、治疗和预后。27 名诊断为频繁 AIVR 的患者（20 名男性；平均年龄 32.2 ± 17.0 岁）参加了我们的研究。纳入标准如下： (1) 至少 3 次 24 小时动态心电图监测的 AIVR 记录，每次记录间隔超过 1 个月；(2) ECG 上静息异位心室率在 50 到 110 bpm 之间。在具有不同适应症的患者中进行电生理学研究 (EPS) 和导管消融。27 名患者均出现心悸或胸部不适，2 名患者因劳力性晕厥或晕厥前兆。5 名患者发现左心室射血分数 (LVEF) 受损，LVEF 与 AIVR 负荷呈负相关（P < 0.001）。AIVR 负荷超过 73.8%/天可以预测 LVEF 受损，敏感性为 100%，特异性为 94.1%。17 名患者接受了 EPS 和消融，其中 5 名患者的 LVEF 降低。在 60 (32, 84) 个月的中位随访期间，LV 功能受损患者的 LVEF 在出院后 6 个月恢复到正常水平，但扩张型心肌病 (DCM) 除外。两名患者在随访期间死亡。DCM患者死于心力衰竭晚期，另一名拒绝消融的患者因AIVR过度加速发热死亡。频繁的 AIVR 具有独特的临床表现。AIVR 患者负担超过 70%，LVEF 受损，