Hyperkalemia-induced escape capture bigeminy

Abstract

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Unusual electrocardiographic presentation associated with severe hyperkalemia

“…Some drugs such as digoxin, beta-blockers, and calcium channel blockers have been associated with this electrocardiographic abnormality, but they have rarely been associated with hyperkalemia. 1 , 4 After normalization of serum potassium levels, complete resolution of electrocardiographic abnormalities was demonstrated ( Supplementary Figure 2 ). (Question 3, Answer 3).…”

“…Escape capture bigemini is uncommon and is characterized by a ventricular escape beat followed by a beat conducted by the sinus node or below the sinoatrial tissue with subsequent ventricular capture. 1 The ventricular escape beat may originate in the atrioventricular junction or in the ventricle due to intermittent sinus impulse blockage at the sinus node or atrioventricular node, allowing an escape focus below the sinoatrial node to emerge and cause escape capture bigemini. 2 The escape beat does not reset the sinus node due to retrograde conduction block or sinus node entry block.…”

“… 2 The escape beat does not reset the sinus node due to retrograde conduction block or sinus node entry block. 1 , 3 For the capture–escape rhythm to occur, the effective cycle of the primary pacemaker must exceed the escape interval plus the refractory period following the escape complex. 1 (Question 2, Answer 1).…”

“… 1 , 3 For the capture–escape rhythm to occur, the effective cycle of the primary pacemaker must exceed the escape interval plus the refractory period following the escape complex. 1 (Question 2, Answer 1). Furthermore, it cannot be ruled out that it is an escape beat from the junction or ventricular escape with retrograde conduction to the atria and dual AV node properties (atypical Echo beats).…”