From the Guidelines
Ventricular bigeminy is associated with various cardiac and non-cardiac conditions, including structural heart disease, coronary artery disease, cardiomyopathy, heart failure, and valvular heart disease, as well as non-cardiac factors such as electrolyte abnormalities, medication side effects, and lifestyle factors like caffeine and stress consumption 1.
Clinical Associations
The clinical significance of ventricular bigeminy depends on the underlying heart conditions, with greater concern in patients who have structural heart disease or impaired cardiac function. Common cardiac associations include:
- Structural heart disease
- Coronary artery disease
- Cardiomyopathy
- Heart failure
- Valvular heart disease Non-cardiac factors that can trigger ventricular bigeminy include:
- Electrolyte abnormalities (particularly low potassium, magnesium, or calcium)
- Medication side effects (especially from digoxin, antiarrhythmics, and some psychiatric medications)
- Caffeine
- Alcohol
- Nicotine
- Stress
- Lack of sleep
Treatment and Management
Treatment is often unnecessary in asymptomatic patients with normal hearts but may include addressing underlying causes, medication adjustments, or antiarrhythmic therapy in symptomatic cases or those with significant heart disease. According to the 2017 AHA/ACC/HRS guideline, further evaluation and treatment may be warranted in some situations, such as determining the origin of the VT, which may help guide further therapy such as ablation 1.
Key Considerations
In some cases, ventricular bigeminy occurs in individuals with structurally normal hearts and may be benign. However, in patients with underlying heart conditions, ventricular bigeminy may be a sign of underlying cardiac disease and requires further evaluation and management. The 2018 AHA/ACC/HRS guideline recommends careful evaluation of hemodynamic status for optimization of management in patients with ventricular arrhythmias, including those with ventricular bigeminy 1.
From the Research
Ventricular Bigeminy Associations
Ventricular bigeminy is associated with several conditions, including:
- Cardiomyopathy: Studies have shown that frequent premature ventricular contractions, including ventricular bigeminy, can lead to cardiomyopathy 2, 3.
- Left ventricular dysfunction: A high frequency of premature ventricular contractions may be associated with underlying left ventricular dysfunction 3.
- Dilated cardiomyopathy: Ventricular bigeminy has been linked to dilated cardiomyopathy, which can be reversible with treatment 2.
- Symptomatic arrhythmias: Ventricular bigeminy can cause symptoms such as dizziness and syncope, particularly when it occurs at rest and during exercise 4.
- Ischemic heart disease: Ventricular bigeminy has been observed in patients with chronic stable ischemic heart disease, and treatment with antiarrhythmic agents such as amiodarone can be effective in suppressing the arrhythmia 5.
Risk Factors and Treatment
Risk factors for ventricular bigeminy-induced cardiomyopathy include:
- High burden of premature ventricular contractions
- Specific characteristics of the premature ventricular contractions
- Underlying structural heart disease Treatment options for ventricular bigeminy include:
- Medical therapy with beta-blockers, nondihydropyridine calcium channel blockers, and antiarrhythmic agents
- Catheter ablation of the arrhythmogenic focus
- Radiofrequency ablation to suppress the arrhythmia 6, 2, 4