VEBs: (Con)fusion Bigeminy

Report:

Sinus rhythm

VEBs, late-diastolic, in bigeminy

Ventricular fusion beats

Comment:

There are, depending on the VEBs’ timing, different degrees of fusion. Note how the sinus contribution is proportional to the PR interval of the fusion beat: the longer the PR, the less the VEB participates in ventricular depolarisation.

The nurse’s writing is instructive: we all like zebras. Oddly enough, as Marriott points out, it’s the fusion beats which are “plucked out of thin air, without reason, more often than any other electrocardiographic item”. Perhaps the nurse was aware of Marriott’s saying and decided to try her luck elsewhere!

The broadest QRS in the middle of the bottom strip may be a “pure” VEB.

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