From the Guidelines
Bigeminy is a heart rhythm pattern where every normal heartbeat is followed by an abnormal beat, creating a paired pattern, and it is often benign but can indicate underlying heart conditions. This abnormal beat, called a premature ventricular contraction (PVC) or premature atrial contraction (PAC), occurs when the heart's electrical system triggers an early beat from either the ventricles or atria 1. Bigeminy creates a characteristic "thump-pause-thump" sensation that patients may feel as palpitations, skipped beats, or fluttering in the chest. While the provided evidence does not directly discuss bigeminy, it does mention ventricular arrhythmias, including premature ventricular contractions, which are a key component of bigeminy 1. According to the evidence, ventricular arrhythmias, whether simple premature ventricular contractions, complex ventricular ectopy, or nonsustained tachycardia, usually do not require therapy unless they are associated with hemodynamic compromise or occur in the presence of ongoing or threatened myocardial ischemia or LV dysfunction 1. Some key points to consider in the management of bigeminy include:
- Identifying and addressing any underlying causes, such as electrolyte imbalances or medication side effects
- Considering lifestyle modifications, such as reducing caffeine and stress, in symptomatic cases
- Using medications like beta-blockers or calcium channel blockers in symptomatic cases, as they have been shown to be effective in controlling ventricular response in atrial fibrillation 1
- Further evaluation with an ECG, Holter monitor, or echocardiogram may be necessary to determine appropriate management in patients with significant symptoms or underlying heart disease.
From the Research
Definition of Bigeminy
- Bigeminy is an arrhythmia characterized by an alternating pattern of normal and abnormal heartbeats [(2,3)].
- It can be a benign finding, but when accompanied by prolonged QTc intervals, it may be a harbinger of torsades de pointes 2.
Types of Bigeminy
- Escape-capture bigeminy is a well-known arrhythmia characterized by group beating of a junctional beat followed by a conducted sinus beat 4.
- Escape-echo bigeminy is a variant of escape-capture bigeminy, where a junctional beat gives rise to a retrograde P wave, which is then conducted back to the ventricles 4.
Clinical Significance
- Bigeminy can be a sign of underlying cardiac pathology, and its presence warrants immediate investigation and treatment 2.
- Beta-adrenergic blockers have been shown to have antiarrhythmic and antifibrillatory effects, and may be used to treat bigeminy and other arrhythmias [(5,6)].