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Atrial Bigeminy?


Specializes in Critical Care. Has 9 years experience.

This was a first for me:

Last night I recovered a post-op CABG x 2 and mitral valve replacement. Grabbed a ECG strip, glanced at it and went to work. I was busy, so I didn't have an immediate chance to analyze the strip. Anyway, as things slowed down, I had a chance to really look at the strip and I noticed that every other QRS complex was slightly smaller than the preceding one. Also, after the smaller QRS's there was a slight compensatory pause. I looked in other leads (MCL, III) and the result was the same. Also, on the artline and pleth waveforms, every other complex was smaller than the preceding one. I was somewhat puzzled when I called the oncall resident, as was he, so we got a 12-lead. I was thinking electrical alternans associated with tamponade (always assuming the worst, I hurried to double-check my chest tubes). As it turns out, the 12-lead showed atrial bigeminy. I have never encountered such a thing. Anyone have any experience with atrial bigeminy? What causes it exactly? Thanks in advance for any input.

CCL"Babe", BSN, RN

Specializes in pre hospital, ED, Cath Lab, Case Manager. Has 28 years experience.

Yes, I have seen atrial bigemany. I saw it most when I worked tele on a post open heart floor. Some times the electrical pathway is disrupted during MVRs, often these patients will go into atrial fib.

Havin' A Party!, ASN, RN

Specializes in ICU, CM, Geriatrics, Management. Has 10 years experience.

Yes, sometimes associated with AF or LAF.

zambezi, BSN, RN

Specializes in CCU (Coronary Care); Clinical Research.

I have seen this also...Per our protocol, if our patient is having lots of pac's...burts of afib...we digitilize them...(assuming they have not had dig prior...) to prevent afib...


Specializes in CCU/CVU/ICU. Has 15 years experience.

I've seen it a few times. It's generally no 'big deal' as it's usually seen in pt's with advanced lung disease (lots of atrial arrhythmias in these patients!) who are already being treated for a-fib. Atrial arrythmias are (unfortunately) common post-cabg, so i suppose it's seen in these patients as well. An atrial bigeminy is actually a 'better'/more 'organized' rhythm than A-Fib and would be (i'm guessing) less likely to be as 'thrombogenic', or drop an EF significantly...(as compared to A-fib).


Specializes in Flight, ER, ICU, CCU. Has 11 years experience.

I just transported an 83y/o lady w/ this....it was a first for me too. They initially called it 2nd deg HB, but it didn't really fit. There was a normal beat (PRi=.24), followed by another with the same PRi, but starting almost on top of the T wave. The couplet was followed by a P wave and dropped QRS. The dropped QRS i suppose is the compensatory pause ...just the atria forgot to pause:).

cardiacRN2006, ADN, RN

Specializes in Cardiac.

It actually happens to me periodically, usually after an injury. It usually goes away on it's own.

MedicalLPN, LPN

Specializes in Onco, palliative care, PCU, HH, hospice.

Wow, never heard of this, thanks for the post! I'm going to google it to see if I can see a strip of what it looks like


Specializes in Cardiac, Post Anesthesia, ICU, ER.

Atrial Bigeminy is a pretty common arrhythmia in post-CABG or valve replacements, and can often times precipitate into Atrial fibrillation. I've also seen it in quite a few patients in PACU, probably due to some of the hypoxia that they may have due to mildly low resp. rates. Best course of action is to prevent it from becoming something worse, such as Atrial Fib, therefore most of the time I see it in a "cardiac" patient, I'll ask for a dose of IV Lopressor if their pressure is fine, or Digoxin on occasion too.

The great thing about seeing it on a pleth or arterial wave form is that it gives people an idea of what happens to atrial kick and filling pressures when a patient becomes tachycardic.

Here's a strip of it I found online....


hypocaffeinemia, BSN, RN

Specializes in Critical Care.

I see it fairly commonly on those with a Hx of afib.

Occasionally see junctional bigeminy, too.

/monitor tech and nursing student.

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