1/4/2024 0 Comments Junctional escape rhythm![]() ![]() A repeat ECG ( Figure 1B) performed a few minutes later demonstrated sinus rhythm at 70 bpm with resting ST segment depression in the inferolateral leads. This represents an accelerated junctional rhythm with isorhythmic atrioventricular (AV) dissociation. A routine 12-lead electrocardiogram (ECG) ( Figure 1A) demonstrated a narrow complex regular rhythm at 78 bpm with visible P waves immediately following the QRS complexes superimposed on the ST segments. There was no history of cardiac disease in her past. She denied any recent symptoms of cardiac ischemia or failure. E-mail: ECG descriptionĪ 49-year-old woman presented to the Emergency Department with flu-like symptoms for the preceding 3 days. Manuscript received June 2, 2013, final version accepted June 28, 2013.Īddress correspondence to: Dr Adam Lee, Department of Cardiology, Liverpool Hospital Liverpool, NSW, Australia. The authors report no conflicts of interested for the published content. AV dissociation, electrocardiogram, junctional rhythm, retrograde P waves. My next article regarding ECG interpretation will breakdown ventricular rhythms, ventricular ectopic beats, and asystole.AV Dissociation Masquerading as an Accelerated Junctional Rhythm with Retrograde Atrial ActivationĪDAM LEE, MBBS, MMed ( Clin Epi), DAVID RICHARDS, MD, FRACP, FACC and HANY DIMITRI, MBBS, PhD, FRACPĭepartment of Cardiology, Liverpool Hospital, Sydney, Australia I understand interpreting EKGs/ECGs are not the easiest and it takes a lot of practice. The difference between Junctional Escape Beats and Premature Junctional Contractions is the timing of the impulse. The main difference between Junctional Escape Rhythm, Junctional Bradycardia, Accelerated Junctional Rhythm and Junctional Tachycardia is the heart rate. Also note, the QRS complexes are narrow as the AV node is above the ventricles. To know that a rhythm is a type of Junctional Rhythm, look at the P-waves to see if it is inverted before or after the QRS complex or hidden in the QRS. This essentially concludes the breakdown of Junctional Rhythms! The main thing to understand about Junctional Rhythms or Junctional Ectopic Beats is that the impulse originates in the AV node. Image from Summary: Junctional Rhythms and Junctional Ectopic Beats Example: Premature Junctional Contraction (PJC). Essentially, the AV node initiates an impulse before the normal beat. Premature Junctional Contraction (PJC):Ī Premature Junctional Contraction (PJC) is a junctional ectopic beat that occurs prematurely. Note the pause and then the Junctional Escape Beat within the underlying rhythm. Junctional Ectopic Beats: Junctional Escape Beats and Premature Junctional Contractions (PJCs) Junctional Escape Beat:Ī junctional escape beat is essentially a junctional ectopic beat that occurs within the underlying rhythm. FYI: Main difference compared to other junctional rhythms is the decreased rate, less than 40 bpm.PR interval: Normal or short PR interval if P-waves not hidden.FYI: Main difference compared to Accelerated Junctional Rhythm is the increased rate.PR interval: Short PR interval (less than 0.12) if P-wave not hidden.FYI: Main difference between a Junctional Rhythms and Accelerated Junctional Rhythms is the rate.PR interval: Normal or short if there is a P-wave present.P-waves: Usually inverted P-waves before the QRS or after the QRS.P-waves can be in front of the QRS complex, behind the QRS complex, or hidden altogether. P-waves can present themselves in a Junctional Rhythm as inverted. Image from Example: Different waves a P-wave can present itself. FYI: Junctional Rhythms originate from the AV node, so the P-wave will be inverted before or after QRS or completely absent.Įxample: Junctional Escape Rhythm with inverted P-Wave before the QRS complex.PR interval: Normal or short if the P-wave is present.P waves: Usually inverted P-waves before the QRS or after the QRS.Junctional Rhythms Review: Junctional Escape Rhythm: There are also 2 ectopic Junctional Beats that you may see as well that we will discuss as well: Junctional Escape Beats and Premature Junctional Contractions (PJCs). ![]() There are 4 Junctional Rhythms to be discussed: 1. So let us continue to Junctional Rhythms which occurs when the primary pacemaker of the heart is the AV node. If you have not done so already, I suggest you read my articles on the Heart’s Electrical System, Sinus Rhythms and Sinus arrest: ECG Interpretation, and Atrial Rhythms: ECG Interpretation. Now that we have gone through rhythms generated from the SA node and atrium, we will move down to what a rhythm looks like when the AV node generates an impulse and becomes the primary pacemaker of the heart.
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