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- Increased automaticity in AV node + decreased automaticity in sinus node.
- Causes of Accelerated Junctional Rhythm : 
    Digoxin toxicity (the classic cause of AJR)
    Beta-agonists, e.g. isoprenaline, adrenaline
    Myocardial ischaemia
    Myocarditis
    Cardiac surgery
  • Junctional Escape Rhythm : 40-60 bpm
  • Accelerated Junctional Rhythm : 60-100 bpm
  • Junctional Tachycardia : > 100 bpm
 
- Narrow complex rhythm
- Retrograde P waves may be present
   and can appear before, during or after the QRS.
 
- Retrograde P waves are usually
   inverted in the inferior leads (II, III, aVF), upright in aVR + V1.
 
- Short PR interval (< 120 ms)
   indicates a junctional rather than atrial focus.
 
- There may be associated ECG features of digoxin effect or digoxin toxicity.
- Rapid AJR may be difficult to distinguish from AVNRT or AVRT.
  typically non-responsive to vagal manoeuvres
 
- AJR with aberrant conduction may be difficult to distinguish from AIVR 
  fusion or capture beats indicates a ventricular rather than junctional focus.
 
 
 
 
 
 

 
- ESRD 病人出現 junctional rhythm 要立即想到高血鉀的可能性！
- 透析病人發生有症狀的心搏過緩, 裝上 EKG monitor 與做 complete EKG 是第一要務
- 總是優先考慮是否為高血鉀造成的問題
- 詢問用藥病史 (beta-blocker, CCB or digoxin poisoning)
- 有無缺血性心臟病或傳導系統纖維化引起 AV block、SSS 與 VHD 的可能 ？
- 鉀離子稍微高的情況下發生的 junctional rhythm
  透析治療會改善, 但不代表病人的問題單純是高血鉀所引起的, 轉介心臟科進一步評估
 
- 這些 ESRD 病人
  有些也許本身就有竇房節功能有不良 ( SA node dysfunction)
  會因為稍微高的鉀離子, 酸中毒, 或其他 uremic toxin 讓 SA node 的功能較易被抑制
  而跳出 junctional rhythm
 
http://www.drroger.info/hd/bradycardia/
 

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