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__NOTOC__
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{{SI}}
{{Junctional bradycardia}}
 
'''For patient information, click [[Junctional bradycardia (patient information)|here]]'''
 
{{CMG}}; {{AE}} {{M.P}}
{{CMG}}; {{AE}} {{M.P}}


{{SK}} Junctional escape; junctional escape rhythm
{{SK}} Junctional escape; junctional escape rhythm


==Overview==
==[[Junctional bradycardia overview|Overview]]==
Junctional bradycardia is a slow (40 to 60 beats per minute) narrow complex escape rhythm that originates in the [[atrioventricular node]] to compensate for slow or impaired conduction of pacemaker activity in the atrium.
 
==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]].  This [[junctional escape rhythm]] generates a normal, narrow [[QRS complex]] rhythm at a rate below 60 beats per minute (junctional bradycardia) as the electrical impulses once they are generated are conducted with normal velocity down the usual pathways.  [[Retrograde P waves]] (i.e. upside down) [[P waves]] due to retrograde or backward conduction may or may not be present.
 
==Causes==
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Acute coronary syndrome]]
*[[acute renal failure|Acute hyperkalemic renal failure]]
*[[Diabetic ketoacidosis]]
*[[Myocardial rupture]]
*[[NSTEMI]]
*[[organophosphate|Organophosphate poisoning]]
*[[parathion|Parathion poisoning]]
*[[spider bite#spider venom|Poisonous spider bites]]
*[[brain damage|Severe brain injury]]
*[[STEMI]]
 
===Common Causes===
*[[Acetylcholine]]
* [[Acute rheumatic fever]]
*[[Amiodarone]]
* [[Antiarrhythmic agents]]
* [[Beta-blockers]]
* [[Calcium channel blockers]]
*[[Cardiac catheterization]]
* [[Digitalis toxicity]]
*[[Dilated cardiomyopathy]]
*[[Diltiazem]]
*[[Hyperkalemia]]
*[[Hypermagnesemia]]
*[[Hypertensive heart disease]]
* [[Ischemic heart disease]]
*[[Methylprednisolone]]
*[[Phenytoin]]
* [[Sick sinus syndrome]]
* [[Sinus arrest]]
* [[Sinus bradycardia]]
* [[STEMI]]
*[[Verapamil]]
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" |
 
'''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Acute coronary syndrome]], [[acute rheumatic fever]], [[Andersen cardiodysrhythmic periodic paralysis]], [[Brugada syndrome]], [[cardiac tumor#heart in lymphomas|cardiac lymphoma]], [[cardiac tumor]], [[Carotid sinus hypersensitivity|cardioinhibitory syncope]], [[congenital heart disease]], [[congestive heart failure]], [[reperfusion injury|coronary reperfusion therapy]], [[dilated cardiomyopathy]], [[hypertensive heart disease]], [[hypertrophic cardiomyopathy]], [[ischemic heart disease]], [[Jervell and Lange-Nielsen syndrome]], [[long QT syndrome]], [[myocardial infarction]], [[myocardial rupture]], [[myocarditis]], [[NSTEMI]], [[pericarditis]], [[Romano-Ward syndrome]], [[sick sinus syndrome]], [[sinus arrest]], [[sinus bradycardia]], [[sinoatrial arrest|sinus node fibrosis]], [[STEMI]], [[tachycardia-bradycardia syndrome]], [[Timothy syndrome]], [[valvular heart disease]]
|-
|bgcolor="LightSteelBlue"| '''Chemical/Poisoning'''
|bgcolor="Beige"| [[Berberine]], [[grayanotoxin]], [[organophosphate|organophosphate poisoning]], [[parathion|parathion poisoning]], [[spider bite#spider venom|poisonous spider bites]], [[pyrethroid|pyrethroid poisoning]], [[Arizona bark scorpion|scorpion toxin]]
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Acetylcholine]], [[all-trans retinoic acid]], [[amiodarone]], [[anthracyclines]], [[antiarrhythmic drugs]], [[barbiturate]], [[beta-blockers]], [[bupivacaine]], [[calcium channel blockers]], [[carbamazepine]], [[cholinesterase inhibitors]], [[cimetidine]], [[citalopram]], [[clonidine]], [[digitalis]], [[digoxin]], [[diltiazem]], [[diphenhydramine]], [[donepezil]], [[edrophonium]], [[neostigmine]], [[granisetron]], [[guanethidine]], [[halothane]], [[idarubicin]], [[isoprenaline|isoprenaline infusion]], [[lithium]], [[mepivacaine]], [[mesalamine]], [[methyldopa]], [[methylprednisolone]], [[nelfinavir]], [[nicorandil]], [[phenothiazine]], [[phenytoin]], [[procainamide]], [[propafenone]], [[propanolol]], [[propofol]], [[pyridostigmine]], [[remifentanil]], [[reserpine]], [[ropivacaine]], [[tacrine]], [[thiamylal]], [[timolol]], [[tricyclic antidepressants]], [[urapidil]], [[verapamil]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Diabetic ketoacidosis]], [[Hashimoto's thyroiditis]], [[pheochromocytoma]], [[hypothyroidism|profound hypothyroidism]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| [[Berberine]], [[hypothermia]], [[spider bite#spider venom|poisonous spider bites]], [[Arizona bark scorpion|scorpion toxin]]
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Andersen cardiodysrhythmic periodic paralysis]], [[Brugada syndrome]], [[congenital heart disease]], [[Emery-Dreifuss muscular dystrophy]], [[Jervell and Lange-Nielsen syndrome]], [[Limb-girdle muscular dystrophy|limb-girdle muscular dystrophy type 1B (LGMD1B)]], [[muscular dystrophy]], [[myotonic dystrophy]], [[Romano-Ward syndrome]], [[Timothy syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| [[Cardiac catheterization]], [[cardiac transplantation]], [[coronary artery bypass grafting]], [[Fontan procedure]], [[heart surgery]], [[regional anesthesia|infraclavicular brachial plexus block]], [[lung transplantation|post lung transplantation]], [[tilt table testing|tilt testing]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| [[Acute rheumatic fever]], [[Chagas disease]], [[diptheria]], [[Lyme disease]], [[myocarditis]], [[pericarditis]], [[septic shock]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal/Orthopedic'''
|bgcolor="Beige"| [[Muscular dystrophy]], [[myotonic dystrophy]], [[Timothy syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional/Metabolic'''
|bgcolor="Beige"| [[Hypermagnesemia]], [[metabolic acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Small for gestational age|Very low birth weight infants]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[cardiac tumor#heart in lymphomas|Cardiac lymphoma]], [[cardiac tumor]], [[multiple myeloma]], [[pheochromocytoma]]
|-
|-bgcolor="LightSteelBlue"
| '''Ophthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose/Toxicity'''
|bgcolor="Beige"| [[All-trans retinoic acid]], [[amiodarone]], [[barbiturate]], [[digitalis]], [[digoxin]], [[halothane]], [[isoprenaline|isoprenaline infusion]], [[lithium]], [[propanolol]], [[cholinesterase inhibitors]]
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| [[Takotsubo cardiomyopathy]], [[anorexia nervosa|severe anorexia nervosa]]
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Hypoxia]], [[lung transplantation|post lung transplantation]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal/Electrolyte'''
|bgcolor="Beige"| [[Acute renal failure]], [[hyperkalemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheumatology/Immunology/Allergy'''
|bgcolor="Beige"| [[Acute rheumatic fever]], [[scleroderma]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| [[Myocardial rupture]], [[brain damage|severe brain injury]]
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Amyloidosis]], [[idiopathic]]
|-
|}
 
===Causes in Alphabetical Order===
{{col-begin|width=80%}}
{{col-break|width=33%}}
*[[Acetylcholine]]
*[[Acute coronary syndrome]]
*[[Acute renal failure]]
*[[Acute rheumatic fever]]
*[[All-trans retinoic acid]]<ref name="pmid22778455">{{cite journal| author=McGregor A, Hurst E, Lord S, Jones G| title=Bradycardia following retinoic acid differentiation syndrome in a patient with acute promyelocytic leukaemia. | doi=10.1136/bcr.02.2012.5848 | issue= | journal=BMJ Case Rep | pages=  | pmc= | pmid=22778455 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22778455  }} </ref>


*[[Amiodarone]]
==[[Junctional bradycardia historical perspective|Historical Perspective]]==
*[[Amyloidosis]]
*[[Andersen cardiodysrhythmic periodic paralysis]]
*[[Anthracyclines]]
*[[Antiarrhythmic drugs]]
*[[Barbiturate]]
*[[Berberine]]<ref name="pmid23888197">{{cite journal| author=Cannillo M, Frea S, Fornengo C, Toso E, Mercurio G, Battista S et al.| title=Berberine behind the thriller of marked symptomatic bradycardia. | journal=World J Cardiol | year= 2013 | volume= 5 | issue= 7 | pages= 261-4 | pmid=23888197 | doi=10.4330/wjc.v5.i7.261 | pmc=PMC3722425 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23888197  }} </ref>
*[[Beta-blockers]]
*[[Brugada syndrome]]
*[[Bupivacaine]]
*[[Calcium channel blockers]]
*[[Carbamazepine]]
*[[Cardiac catheterization]]
*[[cardiac tumor#heart in lymphomas|Cardiac lymphoma]]
*[[Cardiac transplantation]]
*[[Cardiac tumor]]
*[[Carotid sinus hypersensitivity|Cardioinhibitory syncope]]<ref name="pmid17971422">{{cite journal| author=Mehlsen J, Kaijer MN, Mehlsen AB| title=Autonomic and electrocardiographic changes in cardioinhibitory syncope. | journal=Europace | year= 2008 | volume= 10 | issue= 1 | pages= 91-5 | pmid=17971422 | doi=10.1093/europace/eum237 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17971422  }} </ref>
*[[Chagas disease]]
*[[Cholinesterase inhibitors]]
*[[Cimetidine]]
*[[Citalopram]]
*[[Clonidine]]
*[[Congenital heart disease]]
*[[Congestive heart failure]]
*[[Coronary artery bypass grafting]]
*[[reperfusion injury|Coronary reperfusion therapy]]
*[[Diabetic ketoacidosis]]
*[[Digoxin]]
*[[Dilated cardiomyopathy]]
*[[Diltiazem]]<ref name="pmid12101159">{{cite journal| author=Isbister GK| title=Delayed asystolic cardiac arrest after diltiazem overdose; resuscitation with high dose intravenous calcium. | journal=Emerg Med J | year= 2002 | volume= 19 | issue= 4 | pages= 355-7 | pmid=12101159 | doi= | pmc=PMC1725910 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12101159  }} </ref>
*[[Diphenhydramine]]
*[[Diptheria]]
*[[Donepezil]]
*[[Edrophonium]]
*[[Emery-Dreifuss muscular dystrophy]]


==[[Junctional bradycardia classification|Classification]]==


{{col-break|width=33%}}
==[[Junctional bradycardia pathophysiology|Pathophysiology]]==
*[[Fontan procedure]]
*[[Granisetron]]
*[[Grayanotoxin]]
*[[Guanethidine]]
*[[Halothane]]
*[[Hashimoto's thyroiditis]]
*[[Heart surgery]]
*[[Hyperkalemia]]
*[[Hypermagnesemia]]
*[[Hypertensive heart disease]]
*[[Hypertrophic cardiomyopathy]]
*[[Hypothermia]]
*[[Hypoxia]]
*[[Idarubicin]]
*[[Idiopathic]]
*[[regional anesthesia|Infraclavicular brachial plexus block]]
*[[Ischemic heart disease]]
*[[Isoprenaline|Isoprenaline infusion]]<ref name="pmid16216767">{{cite journal| author=Brembilla-Perrot B, Muhanna I, Nippert M, Popovic B, Beurrier D, Houriez P et al.| title=Paradoxical effect of isoprenaline infusion. | journal=Europace | year= 2005 | volume= 7 | issue= 6 | pages= 621-7 | pmid=16216767 | doi=10.1016/j.eupc.2005.06.012 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16216767  }} </ref>
*[[Jervell and Lange-Nielsen syndrome]]
*[[Limb-girdle muscular dystrophy|Limb-girdle muscular dystrophy type 1B (LGMD1B)]]
*[[Lithium]]
*[[Long QT syndrome]]
*[[Lyme disease]]
*[[Mepivacaine]]
*[[Mesalamine]]
*[[Metabolic acidosis]]
*[[Methyldopa]]
*[[Methylprednisolone]]<ref name="pmid10074612">{{cite journal| author=Guillén EL, Ruíz AM, Bugallo JB| title=Hypotension, bradycardia, and asystole after high-dose intravenous methylprednisolone in a monitored patient. | journal=Am J Kidney Dis | year= 1998 | volume= 32 | issue= 2 | pages= E4 | pmid=10074612 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10074612  }} </ref>
*[[Muscular dystrophy]]
*[[Myocardial infarction]]
*[[Myocardial rupture]]
*[[Myocarditis]]
*[[Myotonic dystrophy]]
*[[Nelfinavir]]<ref name="pmid10476763">{{cite journal| author=Landovitz RJ, Sax PE| title=Symptomatic junctional bradycardia after treatment with nelfinavir. | journal=Clin Infect Dis | year= 1999 | volume= 29 | issue= 2 | pages= 449-50 | pmid=10476763 | doi=10.1086/520237 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10476763  }} </ref>
*[[Neostigmine]]
*[[Nicorandil]]
*[[NSTEMI]]
*[[organophosphate|Organophosphorus poisoning]]
*[[parathion|Parathion poisoning]]
*[[Pericarditis]]


==[[Junctional bradycardia causes|Causes]]==


{{col-break|width=33%}}
==[[Junctional bradycardia differential diagnosis|Differentiating Junctional bradycardia from other Disorders]]==
*[[Phenothiazine]]
*[[Phenytoin]]
*[[Pheochromocytoma]]
*[[spider bite#spider venom|Poisonous spider bites]]
*[[lung transplantation|Post lung transplantation]]
*[[Procainamide]]
*[[hypothyroidism|Profound hypothyroidism]]
*[[Propafenone]]
*[[Propanolol]]
*[[Propofol]]
*[[pyrethroid|Pyrethroid poisoning]]
*[[Pyridostigmine]]
*[[Remifentanil]]
*[[Reserpine]]
*[[Romano-Ward syndrome]]
*[[Ropivacaine]]
*[[Scleroderma]]
*[[Arizona bark scorpion|Scorpion toxin]]
*[[Septic shock]]
*[[anorexia nervosa|Severe anorexia nervosa]]
*[[brain damage|Severe brain injury]]
*[[Sick sinus syndrome]]
*[[Sinus arrest]]
*[[Sinus bradycardia]]
*[[Sinoatrial arrest|Sinus node fibrosis]]
*[[Sjogren's syndrome]]
*[[STEMI]]
*[[Tachycardia-bradycardia syndrome]]
*[[Tacrine]]
*[[Takotsubo cardiomyopathy]]
*[[Thiamylal]]
*[[tilt table testing|Tilt testing]]<ref name="pmid22427080">{{cite journal| author=Zyśko D, Gajek J, Agrawal AK, Rudnicki J| title=[The relevance of junctional rhythm during neurocardiogenic reaction provoked by tilt testing]. | journal=Kardiol Pol | year= 2012 | volume= 70 | issue= 2 | pages= 148-55 | pmid=22427080 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22427080  }} </ref> 
*[[Timolol]]
*[[Timothy syndrome]]
*[[Tricyclic antidepressants]]
*[[Urapidil]]
*[[Valvular heart disease]]
*[[Verapamil]]<ref name="pmid17698788">{{cite journal| author=Cohen AS, Matharu MS, Goadsby PJ| title=Electrocardiographic abnormalities in patients with cluster headache on verapamil therapy. | journal=Neurology | year= 2007 | volume= 69 | issue= 7 | pages= 668-75 | pmid=17698788 | doi=10.1212/01.wnl.0000267319.18123.d3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17698788  }} </ref>
*[[Small for gestational age|Very low birth weight infants]]
{{col-end}}


==Epidemiology and Demographics==
==[[Junctional bradycardia epidemiology and demographics|Epidemiology and Demographics]]==
===Age===
Benign junctional rhythms are common during sleep in both children and athletic young adults.


===Gender===
==[[Junctional bradycardia risk factors|Risk Factors]]==
Males and females are affected equally.


==Natural History, Complications and Prognosis==
==[[Junctional bradycardia natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
The natural history and prognosis of the disease depends upon the underlying cause that triggered the junctional escape rhythm.
A [[junctional escape rhythm]] during sleep is benign in children and young adults.


==Diagnosis==
==Diagnosis==
===Symptoms===
[[Junctional bradycardia history and symptoms|History and Symptoms]] | [[Junctional bradycardia_physical_examination|Physical Examination]] | [[Junctional bradycardia laboratory findings|Laboratory Findings]] | [[Junctional bradycardia electrocardiogram|Electrocardiogram]] | [[Junctional bradycardia EKG examples|EKG Examples]] | [[Junctional bradycardia chest x-ray|Chest X Ray]] | [[Junctional bradycardia echocardiography|Echocardiography]] | [[Junctional bradycardia cardiac MRI|Cardiac MRI]] | [[Junctional bradycardia coronary angiography|Coronary Angiography]]
Symptoms are more likely if the atrial rate is faster than the junctional rate (if [[AV dissociation]] or [[complete heart block]] is present) as compared with the scenario whereby the junctional rate is faster than the atrial rate.  The following symptoms may be present:
* [[Dyspnea]]
* [[Fatigue]]
* [[Lightheadedness]]
* [[Palpitations]]
* [[Presyncope]]
* [[Reduced exercise tolerance]]
* [[Syncope]]
 
===Physical Examination===
====Vitals====
=====Pulse=====
The [[pulse]] is regular at a rate of 40 to 60 beats per minute.
 
====Neck====
* [[Cannon a waves]] may be present if there is delayed atrial contraction against a closed [[tricuspid valve]]
 
===Laboratory Findings===
Based upon the patient's history and demographics, consideration should be given to checking the following:
* [[Digoxin]] levels
* [[Lyme titers]] in patients where the disease is endemic
 
===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 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.
 
===EKG Examples===
Shown below is an EKG with a nodal escape rhythm. Note the lack of P or [[P' wave]]s.  Often the P' wave is hidden in the QRS as the nodal escape conducts down to the ventricle and up to the atrium in a fashion such that the QRS and P' wave occur simultaneously.
 
[[File:Nodal escape rhythm1.jpg|center|500px]]
 
Copyleft images obtained courtesy of ECGpedia,  http://en.ecgpedia.org.
----
 
Example of junctional escape rhythm / junctional bradycardia on telemetry:
 
{{#ev:youtube|S2xnOJfZOPI}}
 
===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


==Treatment==
==Treatment==
===Acute Management===
[[Junctional bradycardia medical therapy|Medical Therapy]] | [[Junctional bradycardia electrical cardioversion|Electrical Cardioversion]] | [[Junctional bradycardia ablation|Ablation]] | [[Junctional bradycardia surgery|Surgery]] | [[Junctional bradycardia primary prevention|Primary Prevention]] | [[Junctional bradycardia secondary prevention|Secondary Prevention]] | [[Junctional bradycardia cost effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Junctional bradycardia future or investigational therapies|Future or Investigational Therapies]]
* Avoid drugs that suppress the [[AV node]] as the junctional bradycardia may be the patient's only escape rhythm
* Treat symptomatic [[digitalis toxicity]] with [[atropine]] and [[digoxin immune Fab]] ([[Digibind]])
===Asymptomatic Patients===
*Among healthy patients with heightened [[vagal tone]], no treatment is necessary
 
===Symptomatic Patients===
* Permanent pacemaker placement in indicated in symptomatic patients with:
:* [[Complete heart block]]
:* High grade [[AV block]]
:* [[Sick sinus syndrome]]


==References==
==Case Studies==
{{Reflist|2}}
[[Junctional bradycardia case study one|Case #1]]


==Related Chapters==
==Related Chapters==
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* [[Junctional tachycardia]]
* [[Junctional tachycardia]]


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Latest revision as of 22:21, 11 September 2013

Junctional bradycardia Microchapters

Home

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Junctional bradycardia from other Disorders

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

EKG Examples

Chest X Ray

Echocardiography

Cardiac MRI

Coronary Angiography

Treatment

Medical Therapy

Electrical Cardioversion

Ablation

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

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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]

Synonyms and keywords: Junctional escape; junctional escape rhythm

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Junctional bradycardia from other Disorders

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | EKG Examples | Chest X Ray | Echocardiography | Cardiac MRI | Coronary Angiography

Treatment

Medical Therapy | Electrical Cardioversion | Ablation | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters


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