Mechanism of supraventricular parasystole

Two patients with supraventricular parasystole (one atrioventricular and one auricular) are reported. In both patients, reentrant extrasystoles appeared to occur as the result of Mobitz type I second-degree entrance block. We believe that when a sinus impulse fell soon after the absolute refractory period of the pathway containing the parasytolic focus, it reached and discharged the focus after marked delay, and thereafter became a reentrant extrasystole. In interectopic intervals containing more than one sinus beat, the number of intervening sinus beats was always even, suggesting the presence of concealed reentrant extrasystolic bigeminy. The observations in the present report and in our previous patients with ventricular parasystole strongly suggest that most cases of parasystole, whether ventricular or supraventricular, or whether intermittent or "continuous," may be governed by second-degree entrance block.