Junctional Rhythms

Introduction Part 2 ECG Interpretation

P Wave & QRS Complex

The coordination of the P wave and QRS complex is also affected by the increased conduction velocity of the electrical impulses in the ventricular myocardium.
The inverted P wave may be seen before or after the QRS complex, or it may be buried within it.
Refer to the image on the next slide to reinforce this concept.

PJC's can occur for a number of different reasons i.e., diet, fatigue, stress, disease, ischemia to name a few.
Premature complexes frequently occur in bradycardic rhythms, but may occur almost any time.
PJC's occur when an early electrical impulse occurs from a location in the atria other than the SA node.

We will be discussing the following complexes and rhythms:

Premature Junctional Complexes and Junctional
Escape Beats
Junctional Rhythm
Accelerated Junctional Rhythm
Junctional Tachycardia
Although not specifically a Junctional rhythm, we include supraventricular tachycardia because it may originate above the ventricles (including the junction).

Authors and Sources

Electrocardiography for Healthcare Professionals, 6th Edition Kathryn Booth and Thomas O'Brien
ISBN10: 1265013470, ISBN13: 9781265013479
McGraw Hill, 2023
Rapid Interpretation of EKG's, Sixth Edition
Dale Dublin
Cover Publishing Company
EKG Reference Guide
EKG.Academy
12 Lead EKG for Nurses: Simple Steps to Interpret Rhythms, Arrhythmias, Blocks, Hypertrophy, Infarcts, & Cardiac Drugs
Aaron Reed
Create Space Independent Publishing
Heart Sounds and Murmurs: A Practical Guide with Audio CD-ROM 3rd Edition
Elsevier-Health Sciences Division
Barbara A. Erickson, PhD, RN, CCRN
The Virtual Cardiac Patient: A Multimedia Guide to Heart Sounds, Murmurs, EKG Jonathan Keroes, David Lieberman
Publisher: Lippincott Williams & Wilkin)
ISBN-10: 0781784425; ISBN-13: 978-0781784429
Project Semilla, UCLA Emergency Medicine, EKG Training Breena R. Taira, MD, MPH
ECG Reference Guide
PracticalClinicalSkills.com