Junctional Rhythms

Electrical impulses that originate

from the AV node (junction).
 AV Node (The Gatekeeper)
Three main functions:
• Slows conduction to allow time
for the atria to contract & empty
its contents (atrial kick) before
the ventricles contract
• Secondary pacemaker (40 – 59 bpm)
• Blocks some of the impulses
from being conducted to the
ventricles when atrial rate is rapid
AV Node P Waves
See Overhead Slide 4-1
Premature Junctional Contraction

A premature junctional contraction (PJC) is an

earl beat that originates in the AV junction.

As a result of increased automaticity within

junctional cells
Premature Junctional Contraction

Rhythm: Premature ectopic beat causes slight irregularity

Rate: Overall HR depends on rate of underlying rhythm
P waves: P wave may be inverted, come after the QRS
complex, or be lost in the QRS complex.
PRI: 0.12 – 0.20 sec on regular beat; ectopic beat is visible PRI
will be < 0.12 sec; if P wave is late or not visible there will be
no PRI.
QRS: Narrow (< 0.12 sec); sometimes wide
Junctional Escape Beat

An ectopic junctional beat that occurs late

within an underlying rhythm

P wave will be inverted (before the QRS),

hidden (within the QRS), or late &
inverted (after the QRS)
 Junctional Escape Beat

Common after a pause in the underlying rhythm:

Sinus arrest
Sinus (exit) block
Nonconducted PAC
Mobitz I
 Junctional Rhythm
Appears secondary to depression of the SA node

Occurs when the SA node is firing at a rate lower

than that of the inherent rate of the AV node

Or if the electrical impulse of the SA node fails to

reach the AV node

If the AV node does receive an impulse within 1 –

1.5 seconds, it is triggered to fire resulting in a
junctional escape beat or rhythm
 Junctional Rhythm
Causes:

Disease of the SA node

Acute MI
Drug Effects (digitalis, quinidine, BB’s, or CCB’s)

May also occur with Complete Heart Block

 Junctional Rhythm

Rhythm: Regular
Rate: 40 – 60 bpm (impulse originates from AV junction)
P waves: Consistently either inverted before QRS, hidden in
QRS complex, or inverted & after the QRS complex
PRI: usually < 0.12 sec but may be 0.12 – 0.20 sec; if P wave is
late or not visible there will be no PRI
QRS: Narrow (< 0.12 sec); sometimes wide
Junctional Rhythm
Accelerated Junctional Rhythm

Causes:

Enhanced automaticity secondary to digitalis

toxicity

Damage to the AV node secondary to acute

inferior wall MI, heart failure, acute rheumatic
fever, myocarditis, valvular heart disease, and
cardiac surgery (especially valve surgery)
Accelerated Junctional Rhythm
Junctional Tachycardia
Causes:

Enhanced automaticity secondary to digitalis

toxicity

Damage to the AV node secondary to acute

inferior wall MI, heart failure, acute rheumatic
fever, myocarditis, valvular heart disease, and
cardiac surgery (especially valve surgery)
 Junctional Tachycardia

Often confused with SVT if the rate is very

fast causing the P wave to become
hidden

If a P wave cannot be differentiated, then it

is acceptable to use the term Paroxysmal
SVT or PSVT to describe the rhythm
 Junctional Tachycardia

Rhythm: Regular (usually)

Rate: 101 – 180 bpm (impulse originates from AV junction)
P waves: Consistently either inverted before QRS, hidden in
QRS complex, or inverted & after the QRS complex
PRI: usually < 0.12 sec but may be 0.12 – 0.20 sec; if P wave is
late or not visible there will be no PRI
QRS: Narrow (< 0.12 sec); sometimes wide
TIME TO WORKOUT!!!
 References
Chernecky, C., et al. (2002). Real world nursing survival guide:
ECG’s & the heart. United States of America: W. B. Saunders
Company.

Huff, J. (2006). ECG workout: Exercises in arrhythmia

interpretation (5th ed.). United States of America: Lippincott,
Williams & Wilkins.

Walraven, G. (1999). Basic arrhythmias (5th ed.). United States

of America: Prentice-Hall, Inc.

www.madsci.com/manu/ekg_rhy.htm