II. 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

III. Findings: Junctional Rhythm

  1. Junctional Escape Rhythm
    1. Normal intrinsic junctional rate is 40-60 bpm
  2. Accelerated Junctional Rhythm (AJR)
    1. Rate 60-100 bpm (faster than intrinsic rate)
  3. Accelerated Junctional Tachycardia
    1. Rate >100 bpm

IV. Findings: P Waves

  1. Timing
    1. Retrograde P Waves may follow QRS
    2. 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

V. Types

  1. AV Nodal Reentrant Tachycardia (AVNRT)
    1. Accessory pathway related re-entrant loop
  2. Automatic Junctional Rhythm
    1. Increased AV Node automaticity

VI. 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)

VII. Resources

  1. Burns (2021) Accelerated Junctional Rhythm, Life in the Fastlane
    1. https://litfl.com/accelerated-junctional-rhythm-ajr/

VIII. References

  1. Mattu (2018) Crit Dec Emerg Med 32(9): 12

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Related Studies

Ontology: Junctional Tachycardia by ECG Finding (C3814872)

Definition (NCI) An electrocardiographic finding of a junctional rhythm with a heart rate which is abnormally elevated. (CDISC)
Definition (NCI_CDISC) An electrocardiographic finding of a junctional rhythm with a heart rate which is abnormally elevated.
Concepts Finding (T033)
English Junctional Tachycardia by ECG Finding, Junctional Tachycardia, JUNCTIONAL TACHYCARDIA, Junctional tachycardia, Junctional Tachycardia by EKG Finding