Bigeminal rhythm
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]
Synonyms and keywords: Bigeminy, bigeminal beat
Overview
Classification
- Atrial bigeminy
- Junctional bigeminy
- Ventricular bigeminy
- Concealed bigeminy
- Escape capture bigeminy
Pathophysiology
Differential Diagnosis
| Bigeminal premature ventricular contractions | Normal, PVC, Normal, PVC... |
| Trigeminal premature ventricular contractions | Normal, Normal, PVC, Normal, Normal, PVC... |
| Quadrageminal premature ventricular contractions | Normal, Normal, Normal, PVC; Normal, Normal, Normal, PVC... |
| Occasional escape complexes | Normal, Normal, Normal, Normal, Pause, Escape... |
| Bigeminal Couplets | Normal, Normal, PVC, PVC, Normal, Normal, PVC, PVC... |
| NS-VT | Normal, Normal, PVC, PVC, PVC, PVC, Normal, Normal, PVC... |
Diagnosis
ECG
Shown below is an EKG depicting atrial bigeminy. The EKG shows a regularly irregular rhythm at a rate of about 75/minute. There are two P wave morphologies best seen in lead V1.
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page
Shown below is an EKG depicting bigeminy. The pacemaker is an atrial pacer set at 30/min. Note the marker channel documenting atrial pacing and then sensing of the QRS in the refractory period of the pacemaker. The paced atrial beats seem to stimulate a normal sinus beat and hence create the bigeminal rhythm.
Copyleft image obtained courtesy of ECGpedia,http://en.ecgpedia.org/wiki/Main_Page