Ventricular Bigeminy

Ventricular bigeminy is named after premature ventricular complexes (PVCs) that happen every second beat. This can happen with alternating sinus or junctional complexes so it is good practice to mention the underlying rhythm as well. The PVCs with ventricular bigeminy may not have a corresponding peripheral pulse. Best practice would be to record the pulse, as it has more clinical significance. ie. with 8 impulses on a six second rhythm, with every alternate beat a PVC, the heart rate may read 80/minute while the pulse rate could be only 40/minute – shock signs and symptoms are possible.

A special case of the disparity between heart rate and pulse can occur with ventricular bigeminy. Ventricular bigeminy is a cardiac rhythm with PVCs every alternate QRS complex. If the PVCs do not have a corresponding pulse, the pulse rate would be equal to 1/2 the heart rate displayed on most cardiac monitors. A seemingly adequate heart rate of 70/minute may have a pulse of only 35/minute!

sinus rhythm, HR 78/min with ventricular bigeminy

1. Six Second ECG Guidebook (2012), T Barill, p. 91, 208

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