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Ventricular ectopic beats with exit block: a retrospective Holter monitor study
Insights
Concealed extrasystoles, often missed on short strips, are common cardiac arrhythmias. Concealed bigeminy and trigeminy frequently occur together, suggesting parasystole with entrainment.
Area of Science:
- Cardiology
- Electrophysiology
Background:
- Ventricular ectopic beats with exit block, known as concealed extrasystoles, are infrequently recognized.
- Previous studies have not well-defined the incidence of these arrhythmias.
Purpose of the Study:
- To determine the incidence of ventricular ectopic beats with exit block (concealed extrasystoles).
- To investigate the association between concealed bigeminy, trigeminy, and parasystole with entrainment.
Main Methods:
- Retrospective analysis of 904 Holter recordings.
- Identification and analysis of 92 recordings with sufficient ventricular ectopic beats.
- Review of 53 recordings for evidence of parasystole.
Main Results:
- Concealed bigeminy (S = 2n - 1) was the most common, found in 46% of analyzed Holters.
- Concealed trigeminy occurred in 13% of Holters and often coexisted with concealed bigeminy.
- Twelve Holters suggested parasystole with entrainment, with five confirming the dysrhythmia.
Conclusions:
- Concealed extrasystoles are more prevalent than previously thought.
- Concealed bigeminy and trigeminy can coexist and their conversion may not alter heart rate.
- Inadequate rhythm strip length hinders diagnosis; parasystole with entrainment is a likely diagnosis for frequent extrasystoles.
Abstract:
A retrospective study was conducted to define the incidence of ventricular ectopic beats with exit block (concealed extrasystoles). Of 904 Holter recordings, 92 were admitted for study on the basis of sufficient ventricular ectopic beats on rhythm strips. Concealed bigeminy conforming to the equation of S = 2n - 1 (where S = the interectopic sinus beat and N = any interger) was the most common and occurred in 42 of 92 (46%) Holters included in this study. Concealed trigeminy was observed in 12 of 92 (13%) studies. These Holters also showed ventricular ectopic beats strongly suggestive of parasystole with entrainment. Of 53 Holters reviewed for parasystole 12 were suggestive of, and five indicated this dysrhythmia. We conclude that: 1. Concealed extrasystoles are more common than previously appreciated. 2. Concealed bigeminy and trigeminy appear together and conversion may not always be associated with a change in heart rate. 3. Recognition of this dysrhythmia is uncommon mostly because of inadequate lengths of rhythm strips. 4. Parasystole with entrainment is suggested as a common dysrhythmia when frequent extrasystoles are present.