From the Guidelines
Yes, bigeminy can occur with premature ventricular contractions (PVCs). Bigeminy is a specific pattern of heart rhythm where every normal heartbeat is followed by a PVC, creating an alternating pattern of normal beat-PVC-normal beat-PVC. This creates a characteristic "coupled" rhythm that can be detected on an electrocardiogram (ECG) 1. PVCs are early, abnormal heartbeats that originate in the ventricles rather than the normal pacemaker of the heart (the sinoatrial node). When these PVCs occur in a bigeminal pattern, it means they're happening regularly after each normal beat.
Causes and Evaluation
This pattern can occur due to various causes including:
- Electrolyte abnormalities
- Medication effects
- Caffeine
- Alcohol
- Stress
- Underlying heart disease While many cases of PVC bigeminy are benign, especially in patients without structural heart disease, persistent bigeminy should be evaluated by a healthcare provider to rule out serious underlying conditions 1.
Treatment and Management
Treatment depends on symptoms and any underlying causes, ranging from:
- Lifestyle modifications
- Medications like beta-blockers or calcium channel blockers
- In some cases, procedures like catheter ablation It's essential to note that frequent PVCs may produce a reversible form of left ventricular (LV) dysfunction, and catheter ablation can be an effective treatment for PVC-induced cardiomyopathy 1.
Key Considerations
- PVCs are common and increase in frequency with age 1
- The presence of PVCs can be associated with increased risk of cardiovascular events and mortality 1
- Evaluation and treatment should focus on identifying and managing underlying causes, as well as alleviating symptoms and preventing complications.
From the Research
Bigeminy and Premature Ventricular Contractions (PVCs)
- Bigeminy can occur with premature ventricular contractions (PVCs) as evidenced by studies that have analyzed the relationship between bigeminy and PVCs 2, 3, 4.
- Ventricular bigeminy is characterized by the alternation of a normal sinus beat with a premature ventricular contraction (PVC), and it can be caused by various mechanisms, including reentrant mechanisms and early afterdepolarizations 2.
- The study by 3 discusses the differential diagnosis of bigeminal rhythms, including ventricular bigeminy, and notes that it usually requires treatment with suppressive drugs.
- Another study 4 characterized ventricular bigeminy in patients with Andersen-Tawil syndrome and compared it to patients with ischemic heart disease, finding that patients with Andersen-Tawil syndrome had a higher burden of episodes of ventricular bigeminy.
Mechanisms and Characteristics
- The mechanism of bigeminy can involve ectopic firing or failure of impulse generation or conduction 3.
- Bigeminy can be associated with delayed impulse conduction, which can produce "escape-capture" bigeminy 3.
- The study by 2 identified a set of ECG characteristics that support the notion that premature ventricular complexes during self-perpetuating ventricular bigeminy may be due to early afterdepolarizations.
- A case study 5 described a long run of PVCs "sandwiched" in between sinus beats, resulting in an almost doubling of the heart rate, and illustrated the concept of partial retrograde conduction.
Clinical Implications
- Bigeminy can have significant clinical implications, and identifying the mechanism of the arrhythmia is crucial for making clinical decisions 3.
- The study by 6 discussed the treatment of PVC-induced cardiomyopathy and noted that antiarrhythmic agents can play an important role in the treatment of this condition.
- The study by 4 found that patients with Andersen-Tawil syndrome had a characteristic burden of episodes of ventricular bigeminy, which could be used to distinguish them from patients with ischemic heart disease.