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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！
https://lifeinthefastlane.com/ecg-library/accelerated-junctional-rhythm/
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