The great escape: junctional escape-capture bigeminy.

Escape-capture bigeminy is a bigeminal rhythm in which each escape beat is followed by a captured beat. This dysrhythmia is very rare, because its manifestation requires the sinus interval to be longer than the escape interval. This is possible only with severe sinus nodal disease, where the intrinsic sinus rate is extremely low, or with a sinus rhythm associated with an accelerated junctional rhythm. The authors review the case of a 75-year-old man who presented with occasional dizziness and near-syncopal episodes. He was diagnosed with escape-capture bigeminy and subsequently underwent pacemaker placement.