Bigeminy and Trigeminy: Atrial Flutter
Report:
Atrial flutter 250/min
Alternating 4:1 & 2:1 (2:1 + 3:2) conduction, with bigeminy (top)
2:1 + 4:3 conduction, with trigeminy (bottom)
Comment:
Typical flutter has a basic 2:1 block and a more distal, Wenckebach block; this combination accounts for the preponderance of even overall conduction ratios in atrial flutter.
If one disregards every second F wave, the remaining ones can easily be configured into a 3:2 pattern of increasing F-to-R intervals before an F is dropped. Below, a trigeminy can be analogously interpreted as 4:3 Wenckebach conduction.
A famous dictum of Marriott's states that all that's bigeminal isn't extrasystolic11. Neither is all that's trigeminal.
Fig 15. Tachycardia in a progressively hypotensive patient with pulmonary hypertension (v. pressure readouts on the strips; the lead was changed after the second strip). What is the evidence that the tachycardia was responsible for the fall in systemic pressure?
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