Complex Trigeminy: Quadrigeminy in Disguise
Report:
Sinus rhythm 73/min
VEB couplets in trigeminy
Ventricular fusion beats (second in each couplet)
Concealed retrograde conduction
Comment:
The first VEB is interpolated between the preceding sinus beat and a fusion beat; hence the fusion beats have a slightly longer PR intervals. The strip is really easy to interpret if one looks at the normal sinus cycle at the beginning of the strip and recognises the first - and most obvious - fusion beat following the first extrasystole. All the subsequent fusion beats are just slightly thinner than their sinus counterparts.
The trigeminy is remarkable in that it consists of four complexes: two sinus beats and two VEBs! It is really quadrigeminy in disguise130. Episodes of plain trigeminy, due to VEB couplets without fusion, are shown below (Fig 178a). These VEB couplets, incidentally, take the same room as a single VEB - two for the price of one!
178a. VEB couplets exposed. 179. Monitor CCU strips during thrombolysis in a 61 year old man with anterior infarction. Are these âreperfusion arrhythmiasâ?
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