PMC4159371_01
Baseline electrocardiogram (EKG); sinus rhythm with monomorphic PVC, bigeminy, fixed coupling interval, and long post-PVC pause. A retrograde P wave is seen merged with the T wave.
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Electrocardiogram and electrical monitoring showed sinus rhythm with persistent ventricular hyperexcitability in the form of ventricular bigeminy: monomorphic PVC with fixed coupling interval and fixed post-PVC cycle length (Fig. 1).
Monitoring (single lead) EKG; strip 1: baseline rhythm, permanent ventricular bigeminy, and administration of 0.5 mg atropine; strip 2: "non-sinus" rhythm (second beat) with persistence of PVC; strip 3: junctional rhythm with decrease in PVC; and strip 4: disappearance of PVC at the end of the strip with persistent junctional rhythm.
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A bedside pharmacological testing with 0.5 mg atropine (bolus) was applied; there was a sinus arrest with a junctional accelerated rhythm within 40 seconds, along with relative disappearance of ventricular ectopy (Fig. 2).
A dual chamber pacemaker (DDD) pacemaker was implanted, programed at 60 bpm; of note, the second beat was a conducted premature atrial complex; the third beat showed a paradoxical atrioventricular (AV) delay shortening because of PVC sensing inside the AV period yielding a safety pacing; ventricular hyperexcitability in the form of bigeminy disappeared.
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It allowed total disappearance of symptoms and nearly complete fading of ventricular ectopy (Fig. 3).