Open AccessAtrial bigeminy with block associated with bradycardia and paroxysmal atrial fibrillation — An important variant of the tachycardia‐bradycardia syndrome
Author(s) -
Washington H. G.,
Ward D. E.,
Camm A. J.,
Spurrell R. A. J.
Publication year - 1979
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960020207
Subject(s) - medicine , bigeminy , cardiology , bradycardia , atrial fibrillation , sinus bradycardia , premature atrial contraction , atrial flutter , tachycardia , anesthesia , atrial tachycardia , heart block , electrocardiography , ventricular tachycardia , heart rate , catheter ablation , blood pressure
Abstract Serial 2‐channel 24 h dynamic ECGs in 7 patients who were referred with the “tachy‐brady” syndrome for consideration for permanent cardiac pacing revealed: 1. atrial premature beats (APBs) which were conducted to the ventricles normally or aberrantly; 2. intermittent atrial bigeminy with block towards the ventricles (this rhythm mimicked sinus bradycardia with ventricular rates of 38‐45 beats/min and the ectopic P waves were visible on only one of the ECG channels); 3. paroxysms of atrial fibrillation initiated by closely coupled APBs. These findings suggested that both the ventricular bradycardia and the atrial fibrillation were caused by frequent APBs and that pacing therapy was unnecessary. Disopyramide was given to 5 patients resulting in suppression of the arrhythmia and relief of symptoms. In one patient there was spontaneous resolution and one patient refused treatment. This variant of the “tachy‐brady” syndrome can be successfully treated by suppression of abnormal atrial impulse formation without recourse to pacemaker implantation.