Junctional Rhythms

The treatment of Junctional rhythms focus more on isolating the underlying issue, and not on the rhythm itself - Patrick McMurray

Junctional Rhythms
Junctional Rhythms

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Junctional Rhythm. St Emlyn's

Junctional rhythm (sometimes known as nodal rhythm) is usually an escape rhythm and arises when there is a failure in the generation of sinus beats as may occur in sino atrial block, or when block in the AV junction causes failure in the transmission of sinus beats (ie in complete heart block). In junctional rhythm there may be no P waves if the atria are not activated retrogradely from the AV junction because of the presence of retrograde block. If retrograde activation of the atria does occur P waves may precede, coincide with or follow the QRS complexes depending on the precise site of origin of the rhythm and the rate of propagation in both anterograde and retrograde directions. The polarity…

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 Junctional Rhythm. St Emlyn's

The polarity of the P wave will usually be the opposite of the P wave recorded in any particular lead during sinus rhythm as atrial activation is occurring in the opposite direction to normal.


✅ Narrow QRS - due to normal (fast) conduction through the ventricles. ✅ Inverted P waves - due to backwards conduction from junction through atria. Inverted before QRS complex (atria fire, then ventricles), inverted within the QRS (buried due to atria and ventricles firing simultaneously), or inverted after the QRS (ventricles fire first, then atria). ✅ PRI - shorter, when present due to closer proximity to AV junction.


The sinoatrial node is the natural cardiac pacemaker located in the upper right atrium. The atrioventricular node is a separate cardiac pacemaker located in the inferior-posterior right atrium. The His bundle is a separate cardiac pacemaker located at the inferior end of the atria and ventricle. A junctional rhythm is an abnormal heart rhythm that originates from the AV node or His bundle.

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