Intermittent parasystole with concealed extrasystolic bigeminy during myocardial infarction

A 72-year-old man demonstrated persistent intermittent ventricular parasystole for 6 days during an acute inferior wall myocardial infarction. Entrance block failure occurred at a critical interval of 1.24 sec. after parasystolic beats with resetting of the parasystolic cycle length. The first ectopic beat in each parasystolic series showed coupling to its second preceding conducted beat, and successive cycle lengths in each series usually showed gradual shortening. Concealed extrasystolic bigeminy was also demonstrated between parasystolic series with the number of intervening conducted beats conforming to the formula 2n + 2. After interpolated parasystolic beats, this formula became 2n + 3.