Escape-capture Bigeminy

Vignette: This 75 yo patient was admitted for dizziness and abdominal pain. How will you interpret this ECG strip?

a.      Junctional rhythm with premature atrial complexes and premature ventricular complexes

b.      Junctional rhythm with conducted PAC’s

c.       Sinus bradycardia conducted normally and with aberrancy, junctional escape beats or escape capture bigeminy

d.      Junctional rhythm with echo beats

Image 1 - 2 Leads

Escape and the Capture by Dr TÍNH NGUYỄN CHÍ

In long lead II, the first complex is the normally conducted PQRST one, the next is the blocked P and the next is a ventricular escape beat ( we can see clearly the wide complex in D3 and D1 at the same time ) and then the cycle repeats. In this case, we see a particular pattern -  escape ventricular beat, next is the captured beat  and the next is the blocked P wave and the cycle repeats ( escape beat- capture beat- blocked P wave ). So this 2^nd degree AV Block and with the specific pattern ( Escape beat-capture beat- block P wave ). So it is called : Escape-capture Bigeminy.