Pulseless idioventricular rhythm (PIVR) is a slow electrical rhythm of ventricular origin without mechanical activity, and it is associated with a mortality rate that approaches 100%. In 1976 high-dose corticosteroids were advocated as beneficial in the treatment of PIVR. A critical review of the early literature suggests that the favorable outcome may have been attributable to variables other than treatment with high-dose steroids. Recent prospective clinical trials have not confirmed the salutory effect of steroids in this dysrhythmia.