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It is a tachycardia associated with the generation of impulses in a focus in the region of the atrioventricular node due to an A-V disassociation. [2] In general, the AV junction's intrinsic rate is 40-60 bpm so an accelerated junctional rhythm is from 60-100bpm and then becomes junctional tachycardia at a rate of >100 bpm.
The first finding is that junctional rhythms are regular rhythms. This means that the time interval between beats stays constant. The next normal finding is a normal QRS. Since the impulse still travels down the bundle of His, the QRS will not be wide. Junctional rhythms can present with either bradycardia, a normal heart rate, or tachycardia. [9]
Also, it can be a normal variant or artifacts, such as: Pseudo-ST-depression, which is a wandering baseline due to poor skin contact of the electrode [3] Physiologic J-junctional depression with sinus tachycardia [3] Hyperventilation [3] Horizontal ST depression in V4, V5, V6 leads during a cardiac stress ECG. Other, non-ischemic, causes include:
Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. [1] In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. [ 1 ]
Junctional ectopic tachycardia (JET) is a rare tachycardia caused by increased automaticity of the AV node itself initiating frequent heartbeats. On the ECG, junctional tachycardia often presents with abnormal morphology P-waves that may fall anywhere in relation to a regular, narrow QRS complex. It is often due to drug toxicity. [22]
JET in a 2-month-old girl following cardiac surgery. In this case the right bundle branch block was present during tachycardia and during normal sinus rhythm. JET is most commonly diagnosed using a 12-lead ECG. The appearance is usually of a tachycardia with rapid, regular ventricular rates of 170-260 beats per minute. [6]
Automatic junctional tachycardia is a type of tachyarrhythmia that originates in the atrioventricular node and His bundle area. It can be referred to as junctional tachycardia, focal junctional tachycardia, or Junctional Ectopic Tachycardia (JET). [10] Patients' heart rates are frequently between 200 and 250 beats per minute.
In a normal heart beat rhythm, the SA node usually suppresses the ectopic pacemaker activity due to the higher impulse rate of the SA node. However, in the instance of either a malfunctioning SA node or an ectopic focus bearing an intrinsic rate superior to SA node rate, ectopic pacemaker activity may take over the natural heart rhythm. [ 3 ]