Bigeminy

What is bigeminy?

Bigeminy is a type of abnormal heart rhythm in which every other heartbeat is a premature contraction or extra heartbeat. The heartbeats between the extra ones are normal.

Normally, your heart beats in a coordinated way as the electrical signal travels from the top to the bottom chambers. In bigeminy, an electrical impulse fires from a separate place in your heart, interrupting this pattern of coordinated beats. This happens with every other beat.

One way to imagine this is that your heart has one drummer at the top keeping a constant beat. After the drummer strikes their drum, a drummer from somewhere else on the field will strike theirs, and they’ll trade off every other beat.

Types of bigeminy

Bigeminy can start in different parts of your heart.

Atrial bigeminy happens in your upper heart chambers (atria). The extra heartbeats are premature atrial contractions.

Ventricular bigeminy happens in your lower heart chambers (ventricles). The extra heartbeats are premature ventricular contractions.

What are the symptoms of bigeminy?

Bigeminy symptoms include:

• Chest pain.
• Heart palpitations.
• Dizziness.
• Fainting.
• Hyperventilation (fast, deep breathing).
• Fatigue.

Some people who have bigeminy don’t experience symptoms.

What causes bigeminy rhythm?

Signaling issues in your heart cause bigeminy. These can happen because of conditions such as:

• Heart attack.
• High blood pressure.
• Anemia.
• Hyperthyroidism.
• Cardiomyopathy.
• Mitral valve prolapse.

In addition to your heart’s normal “pacemaker” signals, cells inside your heart may signal your heart to beat. Or you may have blockages in your heart’s normal pathway for heartbeat signals.

What are the risk factors for bigeminy?

Risk factors for bigeminy include:

• Coronary artery disease.
• Heart failure.
• Excessive caffeine use.
• Alcohol use.
• Tobacco product use.
• Anxiety.
• Electrolyte levels that are too high or too low.
• Lack of sleep.

What are the complications of bigeminy?

Bigeminy may cause cardiomyopathy, or a weakening of your heart muscle. A catheter ablation that successfully treats bigeminy can improve cardiomyopathy as well.

How is bigeminy diagnosed?

A healthcare provider will use a stethoscope to listen to your heart. If they hear extra heartbeats that alternate with normal ones, they may suspect bigeminy and want to order tests to confirm it.

What tests will be done to diagnose bigeminy?

A provider will order tests such as:

• Electrocardiogram (EKG).
• Holter monitor.
• Blood tests.
• Echocardiogram.
• Stress test.

Does bigeminy need to be treated?

If your EKG shows bigeminy, but you don’t have symptoms, you probably won’t need treatment. However, people with symptoms will need treatment.

How is bigeminy treated?

If you have bigeminy symptoms, healthcare providers can treat you with medicine. If you have symptoms and cardiomyopathy, you may need a procedure called catheter ablation.

Medicines for bigeminy target lowering your heart rate. They may not be fully effective in stopping the bigeminy or alleviating symptoms. People who don’t find relief from medications may have a catheter ablation. This procedure has a success rate of 75% or higher.

Specific medicines/procedures used

Bigeminy treatments include:

• Beta-blockers.
• Potassium channel blockers such as amiodarone (Cordarone® or Pacerone®).
• Calcium channel blockers.
• Catheter ablation.

Complications/side effects of the treatment

Any medication can have side effects, but the benefits of medication usually make it worth taking. Talk with your healthcare provider if you have concerns.

Possible side effects from medicines to treat bigeminy include:

• Dizziness.
• Lightheadedness.
• Fatigue.
• Upset stomach.
• Headaches.

Although complications rarely happen after catheter ablation, it’s possible to have:

• Infection.
• Bleeding.
• Damage to a blood vessel or heart tissue.
• Blood clots.
• Stroke.

How long does it take to recover from this treatment?

You’ll need several weeks to recover completely after a catheter ablation. During this time, you may still have some bigeminy.

How can I lower my risk of bigeminy?

You may be able to lower your risk of bigeminy by changing risk factors that are under your control. You can:

• Manage high blood pressure.
• Avoid drinking too much caffeine.
• Limit your alcohol use.
• Get the right amount of sleep every night.
• Manage stress to prevent anxiety.
• Avoid tobacco products.

What can I expect if I have bigeminy?

You shouldn’t need to do much if you don’t have symptoms.

However, if you have symptoms, your healthcare provider may advise you to avoid caffeine or recreational drugs and drink less alcohol.

They may prescribe medicine for you. Some people also need a catheter ablation.

Outlook for bigeminy

The outlook for people with bigeminy depends on whether they have heart disease and other risk factors. Bigeminy may be a sign of a higher risk of death in people who have heart disease. For other people, the risk of death is no higher than for the average person.

People who have bigeminy without symptoms have a good prognosis.

How do I take care of myself?

For the best results, follow your provider’s instructions. You may need to consume less caffeine or find ways to reduce your stress level. Be sure to take any prescribed medication according to the label on the bottle.

When should I see my healthcare provider?

It’s important to keep your regular appointments with your provider, but you should contact them if:

• You’re having new or different symptoms.
• Your symptoms get worse.
• The medicine you’re taking is causing bad side effects.

What questions should I ask my doctor?

Questions to ask your provider may include:

• How much do I need to cut down on my caffeine intake?
• How often do I need to see you for follow-up appointments?
• Can you recommend ways to bring my stress level down?
• Can you refer me to a program to help me stop using tobacco products?

A note from Cleveland Clinic

You may feel concerned when a healthcare provider tells you that you have extra heartbeats in your heart rhythm. But most people without bigeminy symptoms don’t need treatment. Talk with your provider about whether you need treatment for bigeminy. Be sure to keep all follow-up appointments with your provider and take any medications they prescribe.