Escape rhythms

An escape beat is a heart beat arising from an

Sick sinus ectopic focus in the atria, the AV junction, or the
syndrome ventricles when the sinus node fails in its role as a
pacemaker or when the sinus impulse fails to be
conducted to the ventricles as in complete heart
block (see section on Heart Blocks below).
The ectopic impulse in this instance is always late,
appearing only after the next anticipated sinus
beat fails to materialize. If the sinus node failure or
heart block is only brief, the ectopic focus may
SA node gagal mengeluarkan impuls generate only a single escape beat; if the sinus
If failure is brief and recovery is prompt, the result is only a
node failure or heart block is prolonged, the
missed beat (sinus pause). ectopic focus produces a rhythm of escape beats
to assume full pacing function. This escape
If recovery is delayed and no other focus assumes pacing mechanism offers protection against total cardiac
function, cardiac arrest follows. standstill in the event of sinus node failure or
complete heart block.
 Atrial escape Junctional escape

In junctional (AV junctional) beat or rhythm the atrial

depolarization current points cephalad and to the right, away
from lead II and toward lead aVR. Therefore the P wave, if
Atriaescape, either in escape beat or escape rhythm,
seen, would be negative in lead II and positive in lead aVR.
produces a P wave that has abnormal axis and looks different
However this P wave is usually buried by the QRS complex
from the P wave produced by the sinus beat. However,
and not visible. On less common occasions when the P wave
depolarization spreads to the ventricles normally down the AV
is visible, it may be either immediately before or immediately
junction, the His bundle, and bundle branches. Therefore the
after the QRS complex. Since the impulse is conducted to the
QRS complex of the atrial escape beats looks exactly like the
ventricles via the His bundle and bundle branches, the QRS
QRS complex of the sinus beat. The inherent rate of atrial
complex of junctional beatsis narrow and looks exactly like
escape rhythm is between 60 and 80 beats/min.
the QRS complex of the sinus beat. The inherent rate of
junctional escape rhythm is 4060 beats/min.