Wing J P, Phibbs B
Heart Lung. 1977 Nov-Dec;6(6):995-1004.
Bigeminal rhythms may arise from ectopic firing or from failure of impulse generation or conduction. In atrial bigeminy a premature atrial beat beat follows each sinus beat. If the PAC is not conducted bradycardia may result; if it is symptomatic treatment with digitalis or quinidine is indicated. Junctional bigeminy may be coupled to sinus beats or may accompany atrial fibrillation. Ventricular bigeminy, the most common type of bigeminy involving ectopic firing, usually requires treatment with suppressive drugs. Concealed bigeminy manifested as PVCs separated by an odd number of sinus beats has the same clinical implications as ventricular bigeminy. Re-entrant premature beats may also be triggered by an artificial ventricular pacemaker. Bigeminy associated with delayed impulse conduction is most often caused by a 3:2 Wenckebach block at the A-V junction but the block may also be at the S-A node or around an ectopic pacemaker. Conduction or production delay may produce "escape-capture" bigeminy in which successive beats are produced by the dominant pacemaker and an alternate one. Implantation of an artificial pacemaker may be appropriate. It is important for the observer to be able to identify the mechanism of any bigeminal rhythm since crucial clinical decisions may attend such identification.
二联律可能源于异位起搏，或冲动产生或传导障碍。在房性二联律中，每个窦性搏动后跟随一个房性早搏。如果房性早搏未下传，可能导致心动过缓；如果有症状，则需用洋地黄或奎尼丁进行对症治疗。交界性二联律可能与窦性搏动耦联，或伴发心房颤动。室性二联律是涉及异位起搏的最常见的二联律类型，通常需要用抑制性药物治疗。隐匿性二联律表现为被奇数个窦性搏动分隔的室性早搏，其临床意义与室性二联律相同。折返性早搏也可能由人工心室起搏器触发。与冲动传导延迟相关的二联律最常见于房室交界区的3:2文氏阻滞，但阻滞也可能发生在窦房结或异位起搏器周围。传导或产生延迟可能导致“逸搏-夺获”二联律，即相继的搏动由主导起搏器和另一个交替起搏器产生。植入人工起搏器可能是合适的。对于观察者来说，能够识别任何二联律的机制很重要，因为这样的识别可能会带来关键的临床决策。
