Junctional tachycardia

Junctional tachycardia (rate about 115/min) dissociated from a slightly slower sinus tachycardia (rate about 107/min) producing one form of double tachycardia; pairs of ventricular capture (C) beats (5th, 6th, 19th, and 20th beats); see laddergram.

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Junctional tachycardia is a form of supraventricular tachycardia characterized by electrical impulse generation from the AV node.

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 rte 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.

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 usual pathways.. Retrograde P waves (i.e. upside down) P waves due to retrograde or backward conduction may or may not be present.

Causes

• Acute MI
• Complete heart block
• Conduction system disease
• Digitalis toxicity.
• Heart surgery
• Ischemic heart disease
• Isoproterenol infusion
• NSTEMI
• Sinus arrest
• Sinus bradycardia
• STEMI

Differentiation of Junctional Tachycardia from other Tachycardias

• Sinus tachycardia:
• Atrioventricular nodal reentrant tachycardia: It can appear similar to atrioventricular nodal reentrant tachycardia.

One form is junctional ectopic tachycardia.

See also

• Junctional rhythm