Longstanding persistent accelerated idioatrial rhythm: Benign sinus node‐like rhythm or insidious rhythm?
Accelerated idioatrial rhythm (AIAR) is not an uncommon atrial arrhythmia since the adventure of Holter monitoring. It has been reported to be most commonly observed in patients with coronary artery disease, postablation, cannabis use, or heterotaxy syndrome.1 Patients who experience AIAR often are asymptomatic due to its transient behavior and relatively slow heart rate (HR). Thus, AIAR is clinically considered to be a benign rhythm and of little clinical significance. However, in some rare cases, AIAR is longstanding persistent, which could be observed throughout 24‐hour Holter monitoring and well chronotropic. The sinus node activity in such cases is suppressed, but can be revealed under provocation. Systemic description of such an unusual rhythm is lacking, and hence in the current study, we describe the clinical manifestations, electrophysiological characteristics, diagnosis, treatment, and prognosis of longstanding persistent AIAR.