Interpolation in Alternate Cycles
Report:
Sinus rhythm 51/min
VEBs, interpolated in alternate cycles
Trigeminy
Non-specific ST/T changes
Comment:
The VEBs are typical, with nonsense axis and qR morphology in V1; their concealed retrograde conduction114, prolonging the PR intervals of the post-VEB sinus beats, also attests to their ventricular ectopic provenance.
This pattern is relatively common, being, as it were, a variant of bigeminy. If alternate P waves were completely blocked (rather than just having their PR intervals increased) this would become obvious bigeminy.
A more orthodox trigeminy, from the same source, was present in the patientâs preoperative ECG (Fig 128a).
Retrograde concealed conduction and block in the same trace (but from a different patient) are shown in 128b.
128a. The commonest form of trigeminy.
128b. Alternate-cycle intercalation in the middle of the trace. 129c. Same patient as in Fig 129b. Bigeminy transformed by concealed retrograde conduction instead of retrograde block.
129. 63 year old lady following PTCA complicated by a femoral artery tear.
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