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Atrioventricular Junctional Rhythms – Junctional Escape Rhythm

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Atrioventricular Junctional Rhythms – Junctional Escape Rhythm

A junctional escape rhythm has a rate between 40 bpm and 60 bpm. It is a protective mechanism rather than an arrhythmia. The junctional escape rhythm is a regular rhythm with regular R-R intervals. The P wave is inverted and may occur before, after, or be hidden within the QRS complex. 

The inverted P wave that precedes the QRS complex should have a shortened PR interval < 120 milliseconds. Ventricular conduction is normal, so the QRS complex is < 120 milliseconds.

Characteristics of a Junctional Escape Rhythm

  1. A regular rhythm
  2. Rate 40–60 bpm
  3. An inverted P wave that manifests before, after, or hidden within the QRS complex
  4. A shortened PR interval if the P wave is seen before the QRS complex (< 120 milliseconds)
  5. A normal QRS complex (< 120 milliseconds)