Concealed ventricular quadrigeminy linked to atrial quadrigeminy: a manifestation of modulated parasystole.

Analysis of a long electrocardiographic recording including many atrial and ventricular extrasystoles shows that when atrial extrasystoles are in a quadrigeminal distribution, the ventricular extrasystoles also manifest a quadrigeminal distribution or reflect a distributional pattern of concealed quadrigeminy. Conversely, when atrial extrasystoles are other than in a quadrigeminal distribution, the ventricular extrasystoles do not occur in a quadrigeminal or concealed quadrigeminal distribution. This pattern is explained on the basis of modulated parasystole. A biphasic phase-response curve explains the observed phenomena on the basis of variations of the parasystolic cycle length due to the modulating effect of supraventricular beats.