In a typical heart rhythm, the heart beats in an even pattern. The top part of the heart squeezes, then the bottom part of the heart squeezes in regular rhythm. However, sometimes the bottom part of the heart (the ventricles) can beat slightly out of rhythm. This is known as a premature ventricular complex (PVC) or ventricular premature beat. When this occurs in a three-beat pattern, doctors call it trigeminy.
This pattern can be two normal (sinus) beats and one abnormal one. Another trigeminy pattern is two PVCs with one sinus beat.
This rhythm is different from bigeminy, where the heart beats with one sinus beat and one PVC.
What causes this?
The heart conducts its own electricity, usually in a regular route. The electric signals go to certain pathways and parts of the heart that send signals to the nearby heart muscle to beat. In most people, the signals follow an expected pathway that an electrocardiogram (EKG) can trace.
However, in some people, the electricity takes a different path. This can result in abnormal heart rhythms. Atrial fibrillation, or an irregular heartbeat, is one example of an abnormal heart rhythm. Trigeminy is another.
An “irritable” area of the heart is usually the cause of trigeminy. This means that while the electricity is conducted through the heart, an area of the heart sends out a separate signal that affects how the heart beats. In some people, this is a normal heartbeat pattern. Nothing is wrong with their heart, it just conducts beats differently from most of the population.
Stress and exhaustion can also result in trigeminy. These states cause a person’s body to release chemicals associated with stress that stimulate the heart and can lead to PVCs.
In other people, taking something that affects the heart can temporarily cause trigeminy. Examples include:
What are the symptoms?
Most people with trigeminy don’t have symptoms with their heart rhythm. They may go their entire lives having occasional or constant episodes of trigeminy and never know it.
However, sometimes a person may have symptoms related to this heart rhythm. They may feel as if their heart is fluttering in their chest. Other symptoms a person may experience with trigeminy include:
In some people with known heart disease or heart problems, trigeminy can be a concern because the heart may be more likely to go into a harmful heart rhythm. Examples include
These heart rhythms affect the heart’s ability to pump blood effectively throughout the body. At their most severe, these heart rhythms could damage the heart and lead to cardiac arrest.
How it’s diagnosed
A doctor may first identify trigeminy by looking at a person’s EKG tracing. The EKG is a painless test that measures the electrical activity of the heart. The doctor will identify the two regular (sinus) beats, plus the irregular beat. The irregular beat will be consistent in its appearance.
Sometimes a doctor may recommend a test that involves wearing a special monitor called a Holter monitor. It measures a person’s heart rhythm for a period of one to two days. Reviewing the monitor’s results can help a doctor identify how often a person’s heart rhythm is trigeminy.
Trigeminy isn’t necessarily a harmful rhythm. If you don’t have any symptoms related to it, your doctor may not recommend any treatments. They could suggest that you avoid known trigeminy causes, such as caffeine or certain drugs, to see if your heart rhythm returns to normal.
If you’re having symptoms, your doctor may try to identify a potential cause. For example, sometimes after a heart attack a person will have less-common heart rhythms in the form of trigeminy or other variations. A doctor will often prescribe medications, such as antiarrhythmics or beta-blockers, to improve the heart’s function and reduce the chances that abnormal heart rhythms will come back.
Sometimes a doctor may recommend a procedure called a cardiac ablation. This involves inserting a special catheter through the groin and advancing it toward the heart. The doctor will use the catheter to ablate or burn small areas of the heart that are causing abnormal heart rhythms.
What can be done at home
Home treatments for trigeminy involve avoiding the foods and substances known to affect heart rhythm. Engaging in stress-relieving practices and getting more sleep may also help to reduce the heart’s Irritability, decreasing the likelihood that trigeminy will occur.
What’s the outlook?
For most people, trigeminy doesn’t cause any problems or adverse effects. If you do have symptoms, see your doctor. They can recommend a variety of treatments to promote a healthy heart and ideally correct abnormal heart rhythms.