Junctional rhythm

	WikiDoc Resources for Junctional rhythm
Articles
Most recent articles on Junctional rhythm Most cited articles on Junctional rhythm Review articles on Junctional rhythm Articles on Junctional rhythm in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Junctional rhythm Images of Junctional rhythm Photos of Junctional rhythm Podcasts & MP3s on Junctional rhythm Videos on Junctional rhythm
Evidence Based Medicine
Cochrane Collaboration on Junctional rhythm Bandolier on Junctional rhythm TRIP on Junctional rhythm
Clinical Trials
Ongoing Trials on Junctional rhythm at Clinical Trials.gov Trial results on Junctional rhythm Clinical Trials on Junctional rhythm at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Junctional rhythm NICE Guidance on Junctional rhythm NHS PRODIGY Guidance FDA on Junctional rhythm CDC on Junctional rhythm
Books
Books on Junctional rhythm
News
Junctional rhythm in the news Be alerted to news on Junctional rhythm News trends on Junctional rhythm
Commentary
Blogs on Junctional rhythm
Definitions
Definitions of Junctional rhythm
Patient Resources / Community
Patient resources on Junctional rhythm Discussion groups on Junctional rhythm Patient Handouts on Junctional rhythm Directions to Hospitals Treating Junctional rhythm Risk calculators and risk factors for Junctional rhythm
Healthcare Provider Resources
Symptoms of Junctional rhythm Causes & Risk Factors for Junctional rhythm Diagnostic studies for Junctional rhythm Treatment of Junctional rhythm
Continuing Medical Education (CME)
CME Programs on Junctional rhythm
International
Junctional rhythm en Espanol Junctional rhythm en Francais
Business
Junctional rhythm in the Marketplace Patents on Junctional rhythm
Experimental / Informatics
List of terms related to Junctional rhythm

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

See also: Junctional bradycardia for slow junctional rhythms, and junctional tachycardia for fast jucntional rhythms

Overview

Junctional rhythm describes an abnormal heart rhythm resulting from impulses coming from a locus of tissue in the area of the atrioventricular node, the "junction" between atria and ventricles.

Classification

Junctional rhythm can be classified according to the rate of the heart rate as the following:^[1]^[2]^[3]

Junctional Rhythm

The junctional rate is normal.

Junction escape rhythm:

The junctional rate is about 40-60 beats per minute.

Accelerated junctional rhythm:

The juncitonal rate can be accelerated (60-100 beats per minute).

Junctional Bradycardia

The junctional rate may be slow (40-60 beats per minute) in which case the rhythm is referred to as junctional bradycardia.

Junctional Tachycardia

The junctional rate may be rapid in which case the rhythm is referred to as a junctional tachycardia.

Pathophysiology

Physiology

The sinoatrial node in the heart is the pacemaker that determine the rate of the heart beats. The electrical impulse starts from the sinoatrial node then travels through the atria. It continues through the bundle of his, Purkinje fibers, and the ventricles ending one heart beat.^[4]^[5]
This sinus rhythm indicates the atria normally contracts before the ventricles.

Pathogenesis

In junctional rhythm, the heart beats rate are not controlled by the sinoatrial node. The new pacemaker in the junctional rhythm is the atrioventricular node.^[6]
The atria contracts before the ventricles but from a different signal. The impulse contracting the atria comes from the ventricles not the normal impulse coming from the sinoatrial node.^[7]^[8]

Causes

Junctional bradycardia

Acute MI
Acute rheumatic fever
Antiarrhythmic agents
Beta-blockers
Calcium channel blockers
Complete heart block
Conduction system disease
Digitalis toxicity
Diphtheria
Healthy response during sleep in patients with heightened vagal tone
Heart surgery particularly valve replacement or surgery for congenital heart disease
Ischemic heart disease
Lyme disease
NSTEMI
Sick sinus syndrome
Sinus arrest
Sinus bradycardia
STEMI particularly inferior MI involving the posterior descending artery causing ischemia of the AV node due to poor perfusion in the AV nodal artery

Junctional tachycardia

Epidemiology and Demographics

Prevalence

In the United States, the prevalence of junctional rhythm is 166 in 100,000 individuals with sinus node dysfunction.^[10]

Age

The prevalence of junctional rhythm increases with age.

Gender

Men and women are affected equally by juntional rhythm.

Natural History, Complications and Prognosis

Natural History

Complications

Complications of junctional rhythm include the following:^[11]
- Syncope
- Dizziness
- Fatigue

Prognosis

Prognosis of junctional rhythm is good with the proper treatment.

Diagnosis

Electrocardiogram

The QRS complexes are narrow in so far as conduction down the His bundle is normal
The junctional rate may be slow (40-60 beats per minute) in which case the rhythm is referred to as junctional bradycardia
The junctional rate may be normal as shown in the tracing below
The junctional rate may be rapid in which case the rhythm is referred to as a junctional tachycardia
There is dissociation of the narrow complex QRS from an upright atrial p wave or the p wave is missing, or the p wave is retrograde (a retrograde p wave) due to retrograde conduction from the AV node back into the atrium.

EKG Examples

Shown below is an EKG depicting AV dissociation with variable timing of the p wave in relation to the QRS. A narrow complex junctional escape rhythm at 75 beats per minute is present.

Shown below is an EKG with a a regular rhythm at a rate of about 43/minute. There are no P waves to be seen and the QRS duration is about 80 ms. This is a nodal rhythm.

Copyleft images obtained courtesy of ECGpedia, http://en.ecgpedia.org.

Related Chapters

References

↑ Spodick DH (1992). "Normal sinus heart rate: sinus tachycardia and sinus bradycardia redefined". Am Heart J. 124 (4): 1119–21. doi:10.1016/0002-8703(92)91012-p. PMID 1529897.
↑ Thery C, Gosselin B, Lekieffre J, Warembourg H (1977). "Pathology of sinoatrial node. Correlations with electrocardiographic findings in 111 patients". Am Heart J. 93 (6): 735–40. doi:10.1016/s0002-8703(77)80070-7. PMID 871100.
↑ Dobrzynski H, Anderson RH, Atkinson A, Borbas Z, D'Souza A, Fraser JF; et al. (2013). "Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues". Pharmacol Ther. 139 (2): 260–88. doi:10.1016/j.pharmthera.2013.04.010. PMID 23612425.
↑ Merriam-Webster dictionary > Junctional rhythm Retrieved September 2010
↑ Kim D, Shinohara T, Joung B, Maruyama M, Choi EK, On YK; et al. (2010). "Calcium dynamics and the mechanisms of atrioventricular junctional rhythm". J Am Coll Cardiol. 56 (10): 805–12. doi:10.1016/j.jacc.2010.03.070. PMC 3050609. PMID 20797495.
↑ eMedicine:"Junctional Rhythms" http://www.emedicine.com/MED/topic1212.htm
↑ medical dictionary http://medical-dictionary.thefreedictionary.com/retrograde+conduction
↑ Dobrzynski H, Anderson RH, Atkinson A, Borbas Z, D'Souza A, Fraser JF; et al. (2013). "Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues". Pharmacol Ther. 139 (2): 260–88. doi:10.1016/j.pharmthera.2013.04.010. PMID 23612425.
↑ "Junctional Rhythm: Overview - eMedicine". Retrieved 2008-12-21.
↑ Romhilt DW, Doyle M, Sagar KB, Hastillo A, Wolfgang TC, Lower RR; et al. (1982). "Prevalence and significance of arrhythmias in long-term survivors of cardiac transplantation". Circulation. 66 (2 Pt 2): I219–22. PMID 6177443.
↑ Di Biase L, Gianni C, Bagliani G, Padeletti L (2017). "Arrhythmias Involving the Atrioventricular Junction". Card Electrophysiol Clin. 9 (3): 435–452. doi:10.1016/j.ccep.2017.05.004. PMID 28838549.

fi:Junktionaalinen rytmi

Template:WikiDoc Sources

[pmid1529897-1] Spodick DH (1992). "Normal sinus heart rate: sinus tachycardia and sinus bradycardia redefined". Am Heart J. 124 (4): 1119–21. doi:10.1016/0002-8703(92)91012-p. PMID 1529897.

[pmid871100-2] Thery C, Gosselin B, Lekieffre J, Warembourg H (1977). "Pathology of sinoatrial node. Correlations with electrocardiographic findings in 111 patients". Am Heart J. 93 (6): 735–40. doi:10.1016/s0002-8703(77)80070-7. PMID 871100.

[pmid23612425-3] Dobrzynski H, Anderson RH, Atkinson A, Borbas Z, D'Souza A, Fraser JF; et al. (2013). "Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues". Pharmacol Ther. 139 (2): 260–88. doi:10.1016/j.pharmthera.2013.04.010. PMID 23612425.

[4] Merriam-Webster dictionary > Junctional rhythm Retrieved September 2010

[pmid20797495-5] Kim D, Shinohara T, Joung B, Maruyama M, Choi EK, On YK; et al. (2010). "Calcium dynamics and the mechanisms of atrioventricular junctional rhythm". J Am Coll Cardiol. 56 (10): 805–12. doi:10.1016/j.jacc.2010.03.070. PMC 3050609. PMID 20797495.

[6] Medicine:"Junctional Rhythms" http://www.emedicine.com/MED/topic1212.htm

[7] tionary http://medical-dictionary.thefreedictionary.com/retrograde+conduction

[pmid236124252-8] Dobrzynski H, Anderson RH, Atkinson A, Borbas Z, D'Souza A, Fraser JF; et al. (2013). "Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues". Pharmacol Ther. 139 (2): 260–88. doi:10.1016/j.pharmthera.2013.04.010. PMID 23612425.

[urlJunctional_Rhythm:_Overview_-_eMedicine-9] "Junctional Rhythm: Overview - eMedicine". Retrieved 2008-12-21.

[pmid6177443-10] Romhilt DW, Doyle M, Sagar KB, Hastillo A, Wolfgang TC, Lower RR; et al. (1982). "Prevalence and significance of arrhythmias in long-term survivors of cardiac transplantation". Circulation. 66 (2 Pt 2): I219–22. PMID 6177443.

[pmid28838549-11] Di Biase L, Gianni C, Bagliani G, Padeletti L (2017). "Arrhythmias Involving the Atrioventricular Junction". Card Electrophysiol Clin. 9 (3): 435–452. doi:10.1016/j.ccep.2017.05.004. PMID 28838549.

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]