2. 58 year old male Mr.Kannan, who came to
hypertension OP for routine checkup
No H/o chest pain, palpitation or syncope
Known smoker for past 20 years – 10
cigarettes per day
Not an acoholic
Not a K/C/o
DM, CAD, COPD, BA, PTB, Epilepsy, Thyr
oid disease
5. ECG shows alternate complexes with 2
population of P waves P-P interval : 0.6 sec and 1
sec
Alternating PR interval : 0.04 sec and 0.05 sec
Normal axis
QRS duration - 0.8 sec
QT interval 0.4 sec
No ST – T changes
Incomplete compensatory pause
Fixed coupling interval
6. ATRIAL BIGEMINY
DISCUSSION
Due to an ectopic from a single irritable focus in
either of the atria
CAUSES
Stress
Exercise • Drugs
Sympathetic over activity •Caffeine
Smoking •Theophylline
Alcoholism
•Cocaine
•Digoxin
Hyperthyroidism
•Amphetamine
COPD •Isoproterenol
RHD
7. INCOMPLETE COMPENSATORY
PAUSE
It is a feature of atrial ectopic
Sum of the pre and post ectopic interval is less
than the sum of two consequetive intervals
MECHANISM
Transit time required to enter sinus node and reset
it followed by the time required for ensuring sinus
discharge to traverse sino-atrial juntion and
depolarise atria
But In VPD
No influence on SA node
No re-setting of SA node
Complete compensatory pause
8. FIXED COUPLING INTERVAL
Interval between the extra-systole and the
preceding beat tends to be the same for all
unifocal extra-systoles
9. LOCALISATION
RIGHT ATRIAL
Negative / biphasic in V1
Positive followed by negative
LEFT ATRIAL
Positive or biphasic in V1
Negative followed by positive
10. A P-wave algorithm constructed on the basis of findings from 130 atrial tachycardias
correctly localized the focus in 93%
11. In Our ECG, Atrial ectopic localises to High Crista (Left
Atrium)
12.
13. MECHANISM OF ATRIAL BIGEMINAL
RHYTHM
Sinus rhythm with alternate atrial extrasystole
Sinus rhythm with alternate sinus extra systole
Sins rhytym with alternate AV nodal extra systole
conducted retrograde to atria
Sinus rhythm with alternate ventricular
extrasystole conducted to the atria
Sinus rhythm with 3 : 2 SA block
AV nodal rhythm with 3: 2 retrograde AV block