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Accelerated Junctional Tachycardia
Aka: Accelerated Junctional Tachycardia, Junctional Tachycardia, Junctional Rhythm
- Causes
- Acute Coronary Syndrome
- Digoxin Toxicity (esp. with underlying Atrial Fibrillation)
- Beta Adrenergic Receptor Agonists
- Myocarditis
- Cardiac Procedures or Surgery
- Findings: Junctional Rhythm
- Junctional Escape Rhythm
- Normal intrinsic junctional rate is 40-60 bpm
- Accelerated Junctional Rhythm (AJR)
- Rate 60-100 bpm (faster than intrinsic rate)
- Accelerated Junctional Tachycardia
- Rate >100 bpm
- Findings: P Waves
- Timing
- Retrograde P Waves may follow QRS
- Retrograde P Waves may precede QRS
- Typically PR is too short (<120 ms) to be sinus rhythm
- Configuration
- Retrograde P Waves are inverted in inferior leads (II, III, avF)
- Retrograde P Waves are upright in lead V1 and aVR
- Types
- AV Nodal Reentrant Tachycardia (AVNRT)
- Accessory pathway related re-entrant loop
- Automatic Junctional Rhythm
- Increased AV Node automaticity
- 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)
- Resources
- Burns (2021) Accelerated Junctional Rhythm, Life in the Fastlane
- https://litfl.com/accelerated-junctional-rhythm-ajr/
- References
- Mattu (2018) Crit Dec Emerg Med 32(9): 12