Triple ventricular parasystole

This presentation reflects the analysis of an electrocardiographic recording obtained from a patient with hypertensive heart disease. In the initial section of the tracing, fixed coupled monomorphic ectopic ventricular beats occurred in regular trigeminal rhythm. The pattern changed following an atrial extrasystole and several ventricular ectopic beats of various configuration occurred, often in sequence. Analysis demonstrated the presence of three independent parasystolic rhythms, two of which manifested with the character of intermittency, namely they were occasionally reset by extraneous impulses. The interplay of the sinus pacemaker with three parasystolic foci resulted in a very complex arrhythmic pattern. In some periods, however, two out of three ectopic rhythms were inapparent, and the third one manifested with fixed coupled complexes, so that a regular extrasystolic trigeminy ensued, and parasystole was not recognizable.