EKG

Accelerated Junctional Tachycardia

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Accelerated Junctional Tachycardia, Junctional Tachycardia, Junctional Rhythm, AV Nodal Rhythm, Atrioventricular Nodal Escape Rhythm

  • See Also
  1. Supraventricular Tachycardia
  2. Supraventricular Tachycardia Management
  • Mechanism
  1. Ectopic focus from the Atrioventricular Node (AV Node) or proximal Purkinje Fibers
  • Causes
  1. Acute Coronary Syndrome
  2. Digoxin Toxicity (esp. with underlying Atrial Fibrillation)
  3. Beta Adrenergic Receptor Agonists
  4. Myocarditis
  5. Cardiac Procedures or Surgery
  • Findings
  • Junctional Rhythm
  1. Junctional Escape Rhythm
    1. Normal intrinsic junctional rate is 40-60 bpm
    2. Accelerated Junctional Rhythms are faster than 60 bpm
  2. Accelerated Junctional Rhythm (AJR)
    1. Rate 60-100 bpm (faster than intrinsic rate)
  3. Accelerated Junctional Tachycardia
    1. Rate >100 bpm
  1. Timing
    1. P Waves may be subtle or absent
    2. Retrograde P Waves may follow QRS
    3. Retrograde P Waves may precede QRS
      1. Typically PR is too short (<120 ms) to be sinus rhythm
  2. Configuration
    1. Retrograde P Waves are inverted in inferior leads (II, III, avF)
    2. Retrograde P Waves are upright in lead V1 and aVR
  • Types
  1. AV Nodal Reentrant Tachycardia (AVNRT)
    1. Accessory pathway related re-entrant loop
  2. Automatic Junctional Rhythm
    1. Increased AV Node automaticity
  • Management
  • Accelerated Junctional Tachycardia
  1. See Supraventricular Tachycardia Management
  2. Typically does not respond to Vagal Maneuvers
  3. Diltiazem or Metoprolol for rate control (may convert to sinus rhythm)
  • Resources
  1. Burns (2021) Accelerated Junctional Rhythm, Life in the Fastlane
    1. https://litfl.com/accelerated-junctional-rhythm-ajr/
  • References
  1. Mattu (2018) Crit Dec Emerg Med 32(9): 12
  2. Mattu (2022) Crit Dec Emerg Med 36(9): 17