Double ventricular parasystole. Supernormal phase of conduction as a mechanism of intermittent parasystole. Report of a case.

A rare case of spontaneous double ventricular parasystole was studied in depth, together with a critical review of similar cases in the literature. The discussion was focused on 1) the variation of the shortest interectopic interval (SIEI), 2) entrance block and its failure, 3) supernormality as a mechanism of intermittence, and 4) effects of lidocaine and atropine on such an arrhythmia. In double ventricular parasystole a greater than usual variation in the SIEI tended to occur in one of the two parasystolic groups. If, however, such variations were too great in the face of otherwise parasystolic rhythm, presence of intermittence was confirmed. A temporary loss of the entrance block was deemed primarily responsible for the intermittency. That is to say, invasion, discharge, and resetting of one parasystolic focus by another parasystolic impulse during the supernormal phase of the ventricle was considered the cause of an intermittence. In a strict sense, this is the first report in the literature in which the supernormality was clearly indicated as one mechanism of intermittent ventricular parasystole. The advantage of the concept of double ventricular parasystole as compared to single parasystole in defining such a mechanism is stressed.