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Updated: Jan 20, 2026
Ladder Diagrams: Complexation Equilibria
Old teaching tools should not be forgotten: The value of the Lewis ladder diagram in understanding bigeminal rhythms
Pavel Antiperovitch1, Antoni Bayés de Luna2, José Nunes de Alencar3
1Division of Cardiology, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
Abstract:
As medical education evolves, some traditional teaching methods often get forgotten. For generations, the Lewis ladder diagram (LLD) has helped students understand the mechanisms of cardiac arrhythmias and conduction disorders. Similarly, clinicians have used LLDs to communicate their proposed mechanisms to their colleagues and trainees. In this article, we revisit this technique of constructing the LLD and demonstrate this process by describing the mechanisms of various bigeminal rhythms.
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