II. Mechanism
- Ectopic focus from the Atrioventricular Node (AV Node) or proximal Purkinje Fibers
III. Causes
- Acute Coronary Syndrome
- Digoxin Toxicity (esp. with underlying Atrial Fibrillation)
- Beta Adrenergic Receptor Agonists
- Myocarditis
- Cardiac Procedures or Surgery
IV. Findings: Junctional Rhythm
- Junctional Escape Rhythm
- Normal intrinsic junctional rate is 40-60 bpm
- Accelerated Junctional Rhythms are faster than 60 bpm
- Accelerated Junctional Rhythm (AJR)
- Rate 60-100 bpm (faster than intrinsic rate)
- Accelerated Junctional Tachycardia
- Rate >100 bpm
V. Findings: P Waves
VI. Types
-
AV Nodal Reentrant Tachycardia (AVNRT)
- Accessory pathway related re-entrant loop
- Automatic Junctional Rhythm
- Increased AV Node automaticity
VII. Management: Accelerated Junctional Tachycardia
- See Supraventricular Tachycardia Management
- Typically does not respond to Vagal Maneuvers
- Diltiazem or Metoprolol for rate control (may convert to sinus rhythm)
VIII. Resources
- Burns (2021) Accelerated Junctional Rhythm, Life in the Fastlane
IX. References
- Mattu (2018) Crit Dec Emerg Med 32(9): 12
- Mattu (2022) Crit Dec Emerg Med 36(9): 17
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI) | An electrocardiographic finding of an arrhythmia originating from within the atrioventricular node. |
| Concepts | Disease or Syndrome (T047) |
| ICD10 | I49.8 |
| SnomedCT | 195102005, 71792006 |
| English | ARRHYTHMIA NODAL, Arrhythmia nodal, Arrhythmia nodal (NOS), Abnormal sinus arrhythmia, Abnormal sinus arrythmia, Nodal Arrhythmia by ECG Finding, Nodal Arrhythmia by EKG Finding, Nodal Arrhythmia, Nodal rhythm disorder, Nodal arrhythmia, Nodal rhythm disorder (disorder), cardiac arrhythmia; nodal, nodal rhythm; disorder, arrhythmia; nodal, Rhythm disorder, nodal |
| Italian | Aritmia nodale, Aritmia nodale (NAS) |
| Dutch | knooparitmie (NAO), knooparitmie, aritmie; nodaal, hartritmestoornis; nodaal, nodaal ritme; stoornis, nodusaritmie |
| French | Arythmie nodale SAI, Arythmie nodale, ARYTHMIE NODALE, Trouble du rythme nodal |
| German | nodale Arrhythmie (NNB), ARRHYTHMIE NODULAER, nodale Arrhythmie |
| Portuguese | Arritmia nodal NE, ARRITMIA NODAL, Arritmia nodal |
| Spanish | Arritmia nodal (NEOM), ARRITMIA NODAL, arritmia nodal, trastorno del ritmo nodal (trastorno), trastorno del ritmo nodal, Arritmia nodal |
| Japanese | 結節性不整脈（ＮＯＳ）, 結節性不整脈, ｹｯｾﾂｾｲﾌｾｲﾐｬｸ, ｹｯｾﾂｾｲﾌｾｲﾐｬｸNOS |
| Czech | Nodální arytmie, Nodální arytmie (NOS) |
| Hungarian | Nodalis arrhythmia (k.m.n.), Nodalis arrhythmia |
Ontology: Escape nodal (C0541946)
| Concepts | Finding (T033) |
| Dutch | nodale ontsnapping |
| French | Echappement nodal |
| German | Extrasystole nodal |
| Italian | Scappamento nodale |
| Portuguese | Escape da junção auriculoventricular |
| Spanish | Escape nodal |
| Japanese | 結節性補充収縮, ｹｯｾﾂｾｲﾎｼﾞｭｳｼｭｳｼｭｸ |
| Czech | Uniklý junkční stah |
| English | Escape nodal |
| Hungarian | Nodalis escape |
Ontology: Junctional arrhythmia (C0948835)
| Concepts | Disease or Syndrome (T047) |
| Dutch | overgangsaritmie |
| French | Arythmie jonctionnelle |
| German | junktionale Arrhythmie |
| Italian | Aritmia giunzionale |
| Portuguese | Arritmia de junção |
| Spanish | Arritmia del nódulo de unión |
| Japanese | 接合部不整脈, ｾﾂｺﾞｳﾌﾞﾌｾｲﾐｬｸ |
| Czech | Junkční arytmie |
| English | arrhythmias junctional, junctional arrhythmia, arrhythmia junctional, Junctional arrhythmia |
| Hungarian | Junctionalis arrhythmia |
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 |
