Junctional Rhythm

A cardiac rhythm that occurs as a backup pacemaker when the sinus node fails to initiate an impulse; the junction typically fires at 40-60/minute; the P wave is either absent or inverted.

A cardiac rhythm is usually named first by the location of the originating impulse. For example, rhythms that begin in the SA node are called sinus rhythms. Rhythms that originate from the AV junction are called junctional rhythms. Ventricular rhythms originate in the ventricle.

junctional rhythm, HR 58/min

The heart rate is about 58/minute, an acceptable rate. The QRS is narrow making it a supraventricular rhythm. The P waves are absent. The pattern is regular. The only plausible explanation: the impulse comes from low in the AV junction. This is a junctional rhythm. Since the heart rate is typical for the junction (40-60/minute), this rhythm is called a junctional rhythm.

1. Six Second ECG Guidebook (2012), T Barill, p. 104, 112, 115, 199

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