Bigeminy is a heart rhythm that has an extra heartbeat between every normal one. You may feel heart palpitations when this happens, but many people don’t have symptoms. Treatments include medicine or — for a higher success rate — a catheter ablation procedure.
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.
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.
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Bigeminy symptoms include:
Some people who have bigeminy don’t experience symptoms.
Signaling issues in your heart cause bigeminy. These can happen because of conditions such as:
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.
Risk factors for bigeminy include:
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Bigeminy may cause cardiomyopathy, or a weakening of your heart muscle. A catheter ablation that successfully treats bigeminy can improve cardiomyopathy as well.
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.
A provider will order tests such as:
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If your EKG shows bigeminy, but you don’t have symptoms, you probably won’t need treatment. However, people with symptoms will need treatment.
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.
Bigeminy treatments include:
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:
Although complications rarely happen after catheter ablation, it’s possible to have:
You’ll need several weeks to recover completely after a catheter ablation. During this time, you may still have some bigeminy.
You may be able to lower your risk of bigeminy by changing risk factors that are under your control. You can:
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.
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.
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.
It’s important to keep your regular appointments with your provider, but you should contact them if:
Questions to ask your provider may include:
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.
Last reviewed on 01/05/2023.
Learn more about the Health Library and our editorial process.
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Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy