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This study identified three novel variants of concealed bigeminy in electrocardiographic (ECG) recordings. These findings expand our understanding of cardiac arrhythmia patterns beyond typical bigeminy.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Concealed bigeminy is characterized by unifocal extrasystoles separated by odd numbers of sinus beats.
- Understanding variations in extrasystole patterns is crucial for diagnosing cardiac arrhythmias.
Purpose of the Study:
- To analyze electrocardiographic (ECG) strips from patients with concealed bigeminy.
- To identify and describe variants of concealed bigeminy beyond the typical presentation.
Main Methods:
- Analysis of long electrocardiographic (ECG) strips from five patients.
- Identification and classification of different patterns of extrasystole coupling intervals and intervening sinus beats.
Main Results:
- Three distinct variants of concealed bigeminy were observed: an 'even number' variant, an 'interpolated extrasystole' variant, and a 'combined bigeminy and trigeminy' variant.
- The 'even number' variant showed extrasystoles separated predominantly by even numbers of sinus beats.
- The 'combined' variant suggested fluctuations between concealed bigeminy and trigeminy patterns.
Conclusions:
- The study identified and characterized three novel variants of concealed bigeminy.
- These variants represent significant deviations from the classical definition of concealed bigeminy.
- Recognition of these variants is important for accurate arrhythmia diagnosis and management.
Abstract:
Long electrocardiographic strips were analyzed from five patients who exhibited periods of typical "concealed bigeminy," i. e., recurrent unifocal extrasystoles which were separated from one another by odd numbers of normally conducted sinus beats. However, in each of these patients, there were periods in which one of three different variants of concealed bigeminy was observed. Three patients displayed an "even number" variant; i. e., there were large numbers of consecutive extrasystoles which were separated exclusively or preponderantly by even rather than by odd numbers of sinus beats. One other patient exhibited an "interpolated extrasystole" variant: those interectopic intervals which were initiated by an interpolated extrasystole contained an even number of sinus beats, whereas all other interectopic intervals contained an odd number. In the fifth patient, the distribution of the numbers of sinus beats separating extrasystoles was such as to suggest a periodic fluctuation between the classical forms of concealed bigeminy and concealed trigeminy; i. e., a "combined bigeminy and trigeminy" variant.