From the Guidelines
Bigeminy and trigeminy are cardiac rhythm abnormalities where bigeminy is characterized by a pattern of one normal heartbeat followed by one premature beat, and trigeminy is characterized by two normal heartbeats followed by one premature beat, as seen on an electrocardiogram (ECG) 1.
Definition and Causes
- Bigeminy refers to a repeating pattern of two beats, where every normal heartbeat is followed by a premature beat.
- Trigeminy occurs when every two normal heartbeats are followed by a premature beat, creating a repeating pattern of three beats.
- These premature beats are typically premature ventricular contractions (PVCs) or premature atrial contractions (PACs), depending on where they originate.
- The patterns may be caused by electrolyte abnormalities, medication effects, caffeine, alcohol, stress, or underlying heart disease.
Clinical Significance
- Bigeminy and trigeminy can sometimes be benign, especially in patients without structural heart disease.
- However, they may require treatment if they cause symptoms or occur in patients with heart conditions.
- Treatment options include correcting underlying causes, beta-blockers, calcium channel blockers, or antiarrhythmic medications depending on the specific clinical situation and severity of symptoms.
- According to the guidelines for electrocardiography, serial ECGs are recommended to monitor responses to therapy or to verify spontaneous recovery in patients with cardiac conditions 1.
Diagnosis and Management
- The diagnosis of bigeminy and trigeminy is based on the ECG pattern.
- The management of these conditions depends on the underlying cause and the presence of symptoms.
- In patients with bigeminy or trigeminy, it is essential to evaluate for underlying cardiac disease and to monitor for any changes in the ECG pattern or the development of symptoms 1.
- The use of serial ECGs is crucial in monitoring the response to treatment and in detecting any potential complications 1.
From the Research
Bigeminy on ECG
- Bigeminy is an arrhythmia characterized by an alternating pattern of normal and premature beats [ 2 ]
- It can be caused by various mechanisms, including reentrant mechanisms and premature ventricular complexes (PVCs) due to early afterdepolarizations [ 2 ]
- Bigeminy can be classified into different types, including ventricular bigeminy and atrial bigeminy [ 3 ]
- Ventricular bigeminy is characterized by a pattern of alternating normal and premature ventricular beats, while atrial bigeminy is characterized by a pattern of alternating normal and premature atrial beats [ 3 ]
Trigeminy on ECG
- Trigeminy is an arrhythmia characterized by a pattern of three consecutive beats, typically two normal beats followed by a premature beat [ 4 ]
- Trigeminy can be caused by various mechanisms, including reentrant mechanisms and premature ventricular complexes (PVCs) [ 4 ]
- Trigeminy can be classified into different types, including ventricular trigeminy and atrial trigeminy [ 4 ]
Diagnosis and Treatment
- The diagnosis of bigeminy and trigeminy is typically made using electrocardiography (ECG) [ 2 ]
- The treatment of bigeminy and trigeminy depends on the underlying cause and may include medications such as beta-blockers [ 5 ]
- Beta-blockers have been shown to be effective in reducing the frequency and severity of ventricular arrhythmias, including bigeminy and trigeminy [ 6 ]