From the Guidelines
Bigeminy is a cardiac rhythm pattern characterized by the alternation of normal heartbeats with premature ventricular contractions (PVCs), creating a repeating pattern of two beats. This condition is often associated with an increased risk of cardiovascular events and mortality, particularly in individuals with underlying heart disease 1. The presence of PVCs, which are a key component of bigeminy, has been linked to a higher risk of ischemic heart disease events and mortality in middle-aged patients 1. Furthermore, frequent PVCs, defined as at least 1 PVC on a 12-lead ECG or more than 30 PVCs per hour, are associated with increased cardiovascular risk and mortality 1. In patients with bigeminy, it is essential to evaluate for underlying conditions, such as ischemic heart disease or left ventricular dysfunction, which may require further treatment to reduce risk 1. Treatment of bigeminy typically focuses on addressing underlying causes and avoiding triggers, rather than suppressing the PVCs themselves, as antiarrhythmic medications have not been shown to reduce mortality and may even increase the risk of death in certain populations 1. Beta blockers may be considered in some cases to regulate heart rhythm and reduce symptoms 1. Overall, the management of bigeminy should prioritize the identification and treatment of underlying heart conditions, as well as the minimization of triggers and symptoms, rather than the suppression of PVCs themselves. Key considerations in the evaluation and treatment of bigeminy include:
- The presence and frequency of PVCs
- The presence of underlying heart disease or other conditions that may contribute to bigeminy
- The patient's symptoms and quality of life
- The potential risks and benefits of treatment options, including antiarrhythmic medications and beta blockers.
From the Research
Definition and Types of Bigeminy
- Bigeminy refers to a type of irregular heart rhythm characterized by the alternation of normal and premature heartbeats 2.
- There are different types of bigeminy, including atrial bigeminy, junctional bigeminy, and ventricular bigeminy 2.
- Ventricular bigeminy is the most common type of bigeminy involving ectopic firing, where a premature ventricular contraction (PVC) follows each normal heartbeat 2.
Characteristics and Clinical Implications
- Bigeminy can be caused by ectopic firing or failure of impulse generation or conduction 2.
- Ventricular bigeminy usually requires treatment with suppressive drugs 2.
- Concealed bigeminy, where PVCs are separated by an odd number of sinus beats, has the same clinical implications as ventricular bigeminy 2.
- Bigeminy can be associated with delayed impulse conduction, which may be caused by a 3:2 Wenckebach block at the A-V junction 2.
Diagnosis and Treatment
- Bigeminy can be diagnosed using ambulatory ECG monitoring and computer analysis 3.
- Catheter ablation can be used to treat para-hisian premature ventricular contractions using electroanatomical mapping 4.
- Ventricular bigeminy characterization can be performed using 24-h Holter monitoring, which can help distinguish between patients with Andersen-Tawil syndrome and those with ischemic heart disease 5.