VPCs with both negative and positive QRS complexes are seen on the same lead.

  If seen in a patient under Digoxin therapy, it strongly suggests Digoxin intoxication.

  Other than Digoxin intoxication, patients with severe left ventricular systolic dysfunction may also show bidirectional VPCs.




ECG 1. The above 3-channel Holter recording is from a patient with severe left ventricular systolic dysfunction. Bidirectional VPCs with
(positive and negative VPCs).

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ECG 2. Above is an ECG from a heart failure patient under Digoxin therapy. The patient has severe left ventricular systolic dysfunction. Bidirectional VPCs are seen.

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ECKG 3. The 3-channel rhythm tracing above is from a 87 years-old woman with mild renal failure. Because of chronic atrial fibrillation, Digoxin and Metoprolol (beta blocker) had been started. The basic rhythm is atrial fibrillation with no P waves. Bidirectional VPCs are seen. Digoxin intoxication must be remembered when a patient under Digoxin treatment developes bidirecional VPCs.

Dr. Sirli Bulut has donated the above ECG to our website.

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