QALY | What Ventricular Bigeminy Looks Like on Your Watch ECG

Key Takeaways

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Bigeminy comes from the Latin word “twins.” On an ECG strip, it’s shown as a sinus beat with a premature ventricular complex immediately after. Ventricular bigeminy is a sinus rhythm that occurs when every other beat is a premature ventricular contraction (PVC).

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‍How to Spot Ventricular Bigeminy on Your Watch ECG

Ventricular bigeminy is wide and abnormal, bypassing the normal conduction system (His-Purkinje) and directly activating the ventricles. There is usually no P wave. Following this wide, bizarre beat, there is a compensatory pause, meaning that the next beat arrives at the normal RR interval. It consists of one sinus beat followed by a premature ventricular contraction in three or more consecutive cycles.

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These are the characteristics of ventricular bigeminy:

‍Rhythm: Irregular‍
Rate: Depends on the underlying rhythm‍
P wave: Absent‍
QRS: Wide (>0.12sec)

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Ventricular Bigeminy on smartwatch ECG (Apple Watch, Kardia, Samsung, Fitbit) — Example of Ventricular Bigeminy

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Ventricular Bigeminy recorded on Apple Watch, reviewed by QALY — Example of Ventricular Bigeminy recorded on Apple Watch. Notice that Apple Watch couldn't interpret a recording.

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Ventricular Bigeminy recorded on Samsung Watch, reviewed by QALY — Example of Samsung ECG with 7 PVCs in bigeminy pattern (Ventricular Bigeminy) and 1 single PVC.

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Common Symptoms of Ventricular Bigeminy

Ventricular bigeminy often causes few or zero symptoms. That being said, the extra beats can cause unusual sensations in the chest, such as:

Fluttering
Heart pounding
Skipped beats or missed beats
Increased awareness of the heartbeat

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Any Cause for Concern?

If you feel fluttering, pounding, or a sensation of skipped heartbeats in your chest, these sensations may be due to an underlying heart condition or result from caffeine, exercise, or other lifestyle choices. Similar signs and symptoms can be caused by many conditions, such as anxiety, low red blood cell count (anemia), overactive thyroid (hyperthyroidism), and infections.

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As always, if you show signs of potential ventricular bigeminy, contact your healthcare provider as soon as possible to rule out the presence of harmful underlying conditions.

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Still Not Sure How to Spot Ventricular Bigeminy on Your Watch ECG?

Your smartwatch can be your partner in looking after your heart. If you’re concerned about ventricular bigeminy, get your smartwatch ECGs analyzed by experts within minutes on the QALY app: iOS and Android.