Junctional bradycardia electrocardiogram
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mugilan Poongkunran M.B.B.S [2]
Overview
Junctional bradycardia or AV junction rhythm is usually caused by the absence of the electrical impulse from the SA node. This usually appears on an EKG with a normal QRS complex accompanied with an inverted P wave either before, during, or after the QRS complex.
Electrocardiography
A 12 lead EKG should be obtained to evaluate the rhythm. In so far as it may alter treatment, any co-existing rhythm disturbance that may have precipitated junctional bradycardia should be ascertained such as:
- AV dissociation
- Complete heart block
- Digitalis toxicity
- Sinus arrest
- Sinus bradycardia
- ST elevation MI
The characteristic EKG findings in junctional bradycardia patients are:
- The rate is 40-60 beats per minute.
- The rate is generally regular.
- The QRS complex is narrow.
- Retrograde P waves may be present due to retrograde conduction from the AV node. The P waves will be inverted in leads II and III.
- The P wave may be buried within the QRS complex and may not be discernable.
- A slow AV nodal reentry tachycardia (AVNRT) should be excluded.
Holter / Cardiac Event Monitoring
A cardiac event monitor may be helpful in patients with transient symptoms or palpitations to exclude other rhythms such as ventricular tachycardia.
Electrophysiologic Studies
- There is normal conduction in the His bundle, and the His-ventricular interval is normal.
- Preceding each QRS, there should be a His bundle depolarization
- AV conduction is variable
- VA conduction is variable