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Background <p>Accelerated idioventricular rhythm (AIVR) is a common reperfusion arrhythmia, but reports of AIVR triggered by tourniquet deflation in orthopedic trauma surgery are rare.</p> Case presentation <p>A 59-year-old male with left tibiofibular open fracture underwent emergency open reduction and internal fixation. Recurrent AIVR and severe hemodynamic instability occurred twice immediately after tourniquet deflation, with wide QRS complexes, atrioventricular dissociation, and transient ST-segment depression, which was initially misdiagnosed as acute myocardial ischemia. The arrhythmia resolved rapidly after hemodynamic support and rewarming without antiarrhythmic drugs, and the patient recovered uneventfully.</p> Conclusion <p>Tourniquet-induced AIVR is a multifactorial reperfusion-related arrhythmia that can easily be misdiagnosed as myocardial ischemia. It is usually self-limited and responds well to hemodynamic optimization. Strict tourniquet management and prompt differential diagnosis can improve perioperative safety in orthopedic surgery.</p>

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Intraoperative management of accelerated idioventricular rhythm triggered by tourniquet deflation: a case report and mechanistic insights

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月21日

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  • Jueheng Wu,
  • Xiaohan Yang,
  • Yalei Gao,
  • Liang Guo,
  • Fan Yang

摘要

Background

Accelerated idioventricular rhythm (AIVR) is a common reperfusion arrhythmia, but reports of AIVR triggered by tourniquet deflation in orthopedic trauma surgery are rare.

Case presentation

A 59-year-old male with left tibiofibular open fracture underwent emergency open reduction and internal fixation. Recurrent AIVR and severe hemodynamic instability occurred twice immediately after tourniquet deflation, with wide QRS complexes, atrioventricular dissociation, and transient ST-segment depression, which was initially misdiagnosed as acute myocardial ischemia. The arrhythmia resolved rapidly after hemodynamic support and rewarming without antiarrhythmic drugs, and the patient recovered uneventfully.

Conclusion

Tourniquet-induced AIVR is a multifactorial reperfusion-related arrhythmia that can easily be misdiagnosed as myocardial ischemia. It is usually self-limited and responds well to hemodynamic optimization. Strict tourniquet management and prompt differential diagnosis can improve perioperative safety in orthopedic surgery.