Diagnostic criteria

  The presence of two consecutive atrial premature beats.

  The shape of P wave of premature beat is different from that of the sinus P wave.

  Premature atrial beats are generally conducted to ventricles in a normal fashion, resulting in narrow QRS complexes.

  If a premature beat comes very early, it may be conducted to ventricles with aberration, resulting in a wide QRS complex.




ECG 1. Atrial couplet observed during Holter recording. The QRS complexes of the premature beats are narrow and have
P waves with shapes different than those of the sinus beats. To the left, a ventricular premature beat (VPS) is observed with a
full compensatory pause: 632 + 648 = 546 + 734.

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ECG 2. The ECG above was recorded during acute inferior wall myocardial infarction. Atrial couplet is seen.
The P waves of the atrial extrasystoles have a different configuration than sinus P waves.

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ECG 3. The ECG above belongs to a 64 years-old man with coronary artery disease and paroxysmal attacks of ectopic
atrial tachycardia. Two consecutive P waves with different shapes ( two consecutive atrial premature beats ) denote atrial couplet.

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