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We provide our users the most up-to-date and accurate information on the treatment and prevention of cardio pathologies in accordance with current American and European clinical guidelines.
The information provided on this website is for educational purposes only and should not be considered medical advice. Always consult a licensed physician for diagnosis and treatment.
Junctional Rhythm on ECG
Introduction
A junctional rhythm is a type of heart rhythm where the electrical impulses originate from the atrioventricular (AV) junction rather than the sinus node. This can occur due to sinus node dysfunction or increased automaticity of the AV junction.
ECG Features of Junctional Rhythm
- Rate: Typically 40–60 beats per minute (bpm) (if accelerated, 60–100 bpm, termed accelerated junctional rhythm).
- P Waves: Often absent, buried within the QRS complex, or retrograde (inverted in leads II, III, and aVF).
- QRS Complex: Usually narrow (<120 ms) unless there is a concurrent bundle branch block.
- Regularity: Typically regular since the AV junction acts as the primary pacemaker.
Causes of Junctional Rhythm
- Sinus Node Dysfunction: Sick sinus syndrome, sinus arrest.
- Medication Effects: Beta-blockers, calcium channel blockers, digoxin toxicity.
- Ischemic Heart Disease: Inferior wall myocardial infarction affecting the sinoatrial node.
- Electrolyte Imbalances: Hyperkalemia.
- Post-Operative States: Cardiac surgery affecting the conduction system.
Clinical Significance and Management
- Benign and Asymptomatic Cases: Often requires no treatment.
- Symptomatic Cases (e.g., dizziness, syncope): May need evaluation for bradycardia indications.
- Identify and Address Underlying Causes: Medication review, electrolyte correction.
- Pacemaker Consideration: In cases of significant bradycardia or sick sinus syndrome.
Summary
Junctional rhythms are usually a compensatory response but may be pathological in some situations. Proper ECG analysis helps differentiate them from other arrhythmias and guides management.
Source recommendations
1. American Heart Association Guidelines
- https://professional.heart.org/en/guidelines-and-statements
- https://www.heart.org/
- https://professional.heart.org/en/guidelines-statements
- https://cpr.heart.org/en/resuscitation-science/cpr-and-ecc-guidelines
- https://www.heart.org/en/healthy-living/fitness/fitness-basics/aha-recs-for-physical-activity-in-adults
2. European Society of Cardiology Guidelines
- https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines
- https://academic.oup.com/eurheartj/article/42/34/3227/6358713
- https://www.escardio.org/Guidelines
- https://academic.oup.com/eurheartj/article/44/39/4043/7238227
- https://www.escardio.org/
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If you or your loved ones experience any of these symptoms, you should consult a doctor in time. Remember that self-medication can be dangerous, and timely diagnosis will preserve the quality and life expectancy.
The heart is an organ that does not know how to "keep silent" if something goes wrong. Chest pain, shortness of breath, swelling, dizziness, and rhythm disturbances are the symptoms that require our attention. The best prevention of heart disease is careful attention to your health, regular checkups with a doctor, and a healthy lifestyle. Take care of your heart, and it will serve you for many years!
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