Junctional tachycardia pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Normally, the atrioventricular node (AVN) can generate an escape rhythm of 40-60 beats per minute in case the sinoatrial node(SA node) or atrial pacemakers fail (sinus arrest) or slow (sinus bradycardia) or if there is complete heart block. Thisjunctional escape rhythm generates a normal, narrow QRS complex rhythm at a rte below 60 beats per minute (junctional bradycardia) as the electrical impulses once they are generated are conducted with normal velocity down the His-Purkinje system. Retrograde P waves (i.e. upside down) due to retrograde or backward conduction may or may not be present in junctional bradycardia.
In contrast to a junctional escape rhythm or junctional bradycardia at a rate of 40-60 beats per minute, junctional tachycardia is faster, at a rate > 60 beats per minute. Junctional tachycardia generates a normal, narrow QRS complex rhythm as the electrical impulses are conducted with normal velocity down the His-Purkinje system. Retrograde P waves (i.e. upside down) P waves due to retrograde or backward conduction may or may not be present.
The cause of the more rapid firing of the atrioventricular node is thought to be due to enhanced automaticity as a result of abnormal Calcium metabolism in the sarcoplastic reticulum.[1]
References
- ↑ Kim D, Shinohara T, Joung B, Maruyama M, Choi EK, On YK. Calcium dynamics and the mechanisms of atrioventricular junctional rhythm. J Am Coll Cardiol. Aug 31 2010;56(10):805-12.