Tehran University of Medical Sciences The Research in Heart Yield and Translational Medicine (RHYTHM) 3115-7270 19 4 2024 10 30 306 309 Riyaz Charaniya Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Ahmedabad, India. Mit Chaudhari Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Ahmedabad, India. Dinesh Joshi Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Civil Hospital Campus, Ahmedabad, India. 2023 08 25 2024 09 12 Accelerated idioventricular rhythm (AIVR) is a relatively slow ventricular rhythm that often occurs during the reperfusion phase of an acute myocardial infarction. It is generally considered a benign rhythm that does not require treatment. However, we present a case where AIVR was the presenting arrhythmia in a 41-year-old man with acute coronary syndrome, suggesting it might not be as benign as previously reported in the literature. The patient, who presented to our institute, underwent urgent coronary evaluation followed by revascularization, leading to the conversion of AIVR to normal sinus rhythm and improvement in anginal symptoms. https://rhythm.tums.ac.ir/index.php/jthc/article/view/1920