Distribution patterns of ventricular premature complexes in long-term electrocardiographic recordings and their usefulness in disclosing modulated parasystole

Long-term electrocardiographic recordings from 25 patients with abundant ventricular premature complexes (VPCs) were screened with a computer program for sequences of interectopic intervals with the number of sinus beats consistent with manifest or concealed bigeminy/trigeminy. On average, 19.0% of VPCs in this patient series were followed by an uninterrupted sequence of greater than or equal to 10 interectopic intervals with concealed bigeminy. The corresponding figure for concealed trigeminy was 2.2%, for manifest bigeminy 9.6%, and for manifest trigeminy 0.8%. The longest sequence with concealed bigeminy comprised 149 interectopic intervals. The corresponding figure for concealed trigeminy was 135 interectopic intervals. The sequences of concealed bigeminy occurred at significantly lower heart rates than those of concealed trigeminy. These findings can be explained by the entrainment phenomena described in experimental models of modulation of a ventricular parasystolic focus across a zone of impaired conduction.