What are the causes of ventricular arrhythmias, VT, Bigeminy and Trigeminy?

I have blogged about palpitations and VT before. You can read more about that here:


You'll find these are rather common complaints and most people don't need treatment, only reassurance once their heart proves OK.

Trigeminyc(or Bigeminy) can be caused by a host of factors.
There are two kinds of Trigeminy:
1)Two normal beats are followed by an extra beat; this rhythm usually does not progress to dangerous forms of fast ventricular rhythms;
2) A group of 3 beats, usually one normal beat followed by 2 extra beats.
This condition may be caused by other heart disease, or causes that include medications, too much caffeine, cocaine use, stress and other factors.

What are the causes of ventricular arrhythmias?

Some cases are simply "normal variants", occurring in otherwise normal individuals.

Other causes include:

  1. A variety of underlying cardiac conditions, including coronary artery disease, cardiomyopathy, mitral valve prolapse, etc.
  2. Abnormal levels of "electrolytes" (minerals) in the blood. Decreased potassium and/or magnesium are the most common associated abnormalities of electrolytes. Both may be caused by the use of diuretics (water pills), among other reasons.
  3. There are unusual congenital (familial) causes of ventricular arrhythmias.
  4. Abnormal conditions such as increased thyroid hormones, and others.
  5. Toxins, including alcohol.
  6. Stimulants such as
    + Caffeine Nicotine and/or Cocaine can cause serious ventricular arrhythmias.
    + Some over-the-counter medications and herbal/natural formulations contain important stimulants
  7. Infection, inflammation or degeneration of the heart muscle.
  8. Infections at other sites in the body.
  9. They are often worse with lack of sleep, or stress.
  10. There are also other causes.

Dr T



I have known about my  mitral valve prolapse since my 30's, with occasional very short lived- seconds- rapid pulse incidences. I am now 66 and  yesterday I had an incident of tachycardia which did not resolve-went to ER and diagnosed with A-Fib which resolved 3 hours later  just before I was about to be given a heart block medication..so that was not given. I have no other big risk factors.  It was recommended in part that I not drink coffee which I do  about two mugs a day in the morning usually and that I take low dose ASA. Two questions: 1.  If I cut down to one cup of coffee/day is that so bad? I drank it for the "reported" benefits (little) of occular accommodation and other "reported" recent benefits for colon health, etc. and to give me a little energy.  2.  I am skeptical about the low dose ASA every other day, since I tried it years ago and it caused bruising. I looked it up and there are a lot of online articles that recent studies do not suggest it is helpful and could even be cause of non beneficial effects like hemorraging.   What information would you add to this. Thanks. 

1. Drinking coffee and other stimulants may increase the incidence of palpitations and arrhythmias. If you haven't notice any change/improvement there is no need to stop your coffee drinking.

2. One baby ASA/day acts as a pain reliever, heart attack preventer and possible cancer preventer rolled into one tablet. If you have not expereinced any side effect such as bruising with such a small dose I'd recommend you to continue.

Hope this helps,

Dr T

Ive had pvcs for five years. No medications, just nonitored by all sorts of tests. Three weeks ago I developed trgeminis and fainted. Went to hospital. Had angiogram which was clear but I do have small arteries. They dd an ablation that they said was successful. Three weeks later trigeminies are back. I'm 66 years old, female. No other signs of heart disease. What do I do now?

I am surprised your doctors recommended an ablation so early on in your diagnosis/treatment. Go back to your doctors and ask for another evaluation. If necessary, ask for a second opinion from another cardiologist.

Hope this helps,

Dr T

Hi. I'm writing about my 15 daughter. She has been a heart patient from. She had a congenital heart defect transposition of the great vessels. She has been having PVC's. Yesterday while at her cardiologist office she was in trigeminy and is very symptomatic. I am a bit concerned because they acted as if this was no big deal. I know my daughter and I really feel lije something isn't right.

Hi Teresa,

I think you are right to be concerned. Any new arrhythmia needs to be evaluated, especially in a patient with congenital heart defects, whether repaired or not. I advice to call your doctor and ask for an explanation and testing!

Hope this helps,

Dr T

I assume you have been checked for the possible causes of bigeminiPalpitations and Arrhythmias.

Your doctors need to make sure your heart is otherwise normal. Specifically, depending your ag and cardiac risk factors,  coronary artery disease needs to be excluded. This is best done with a Holter monitor, blood tests and a stress ECHO.

Those "sports drinks" may contain caffeine and sugar that are stimulants and may worsen your bigemini. Look above for the other causes. 

Hope this helps,
Dr T

I have ventricular bigeminy , can sports drinks irritate this .

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