Positively Concordant Trigeminy
Report:
Sinus tachycardia 130/min
VEBs in trigeminy
Left atrial abnormality
Minor T wave changes
Comment:
The VEBs are monophasic R complexes from V1 through V6. This is diagnostic of ventricular ectopic origin. A regular run of such beats, however, would have a broader differential diagnosis to include WPW type ‘A’ antidromic SVT, or flutter, and some cases of masquerading bundle branch block.
Below (Fig 23a) is another example of concordant positive precordial pattern in trigeminal VEBs, from 78 year old lady with aortic stenosis and chronic LBBB. She had them for over a year and retained them after implantation of a (defective) permanent pacemaker (Fig 23b).
Single VEBs are the commonest cause of trigeminy and some authors reserve the term for single premature beats separated by two sinus or other supraventricular beats. This is too narrow. There is no reason why any sustained beating in groups of three should not be called trigeminy.
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