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Images and Case Reports in Arrhythmia and Electrophysiology

Electrocardiographic Imaging of Ventricular Bigeminy in a Human Subject

Yong Wang, MS; Li Li, MS; Phillip S. Cuculich, MD and Yoram Rudy, PhD

From the Cardiac Bioelectricity and Arrhythmia Center (Y.W., L.L., Y.R.) and the Cardiovascular Division, Department of Medicine (P.S.C., Y.R.), Washington University in Saint Louis, Mo.

Correspondence to Yoram Rudy, PhD, The Cardiac Bioelectricity and Arrhythmia Center, 290 Whitaker Hall, Campus Box 1097, One Brookings Dr, Saint Louis, MO 63130-4899. E-mail rudy@wustl.edu

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Ventricular bigeminy refers to the appearance of paired different ventricular complexes in the body-surface ECG (Figure, A inset, lead V2). From this ECG morphology, it has been inferred that bigeminy is generated by interaction between an extrasystolic beat and a regular periodic ventricular beat.¹ The regular beat is typically generated by sinus rhythm but could also be a paced rhythm. The mechanism of ventricular bigeminy was inferred mainly on the basis of analysis of body-surface ECG signals.^1,2 However, the ECG measures the reflection of cardiac electrical activation at a limited number of points, on the body surface, remote from the heart. It does not provide detailed information about cardiac activation patterns, data that are necessary for understanding the mechanism of ventricular bigeminy.

View larger version (54K):   Figure. A, The ventricular activation sequence during bigeminy. Top row shows activation sequence for a paced beat from a pacemaker lead located at right ventricular (RV) apex (black asterisk) in the anterior and posterior views (with atria removed). Bottom row shows activation during an extrasystolic beat from a left ventricular (LV) ectopic site (triangles). B, Ventricular activation sequence during 2 different fusion beats between the paced beat and extrasystolic beat. In the top row, the onset of paced activation precedes that of extrasystolic activation by 15 ms. In the bottom row, the extrasystole onset precedes the paced beat by 10 ms. RA indicates right atrium; SVC, superior vena cava; IVC, inferior vena cava; MV, mitral valve; and TV, tricuspid valve. The solid black line in the . . . [Full Text of this Article]