Sinus Bradycardia: Escape-Capture Bigeminy
Report:
Sinus bradycardia 38/min 3
Ventricular pacemaker escape beats 2
Escape-capture bigeminy 4
Nonspecific ST/T changes 1
Comment:
A precondition for escape-capture bigeminy is a very long effective supraventricular cycle, created in this instance by sinus bradycardia (sinus rhythm with, e.g., 2:1 block would have done as well). Another precondition is the absence of retrograde conduction from the subsidiary (escape) pacemaker – or else the slow rhythm would be wiped out altogether.
Before Marriott’s classical description29 this rhythm was called “pseudoreciprocal”, because of the P wave between the complexes. It maintenance is, as Marriott aptly put it, “an arithmetic caprice” – a coincidental relationship between the two cycle lengths.
Incidentally, the rhythm strip is mislabelled as I instead of II. Lead II is not a good one for ventricular conduction, as shown in this example.
Fig 47. 88 year old man, confused and hypotensive.
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Sinus bradycardia Escape-capture bigeminy Pacemaker electronic pacemaker-sinus Marriott
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