Junctional Rhythms

Premature Junctional Complex (PJC) and Junctional Escape Beats ECG Interpretation

Part I

PJC’s and Junctional Escape Beats may occur for a number of different reasons i.e., diet, fatigue, stress, disease, ischemia
Premature complexes and Junctional Escape Beats frequently occur in bradycardic rhythms, but may occur almost any time.
Morphologically there is no difference between PJC’s and Escape Beats.

After reviewing the previous slide you should note that the difference is that PJC’s occur early and disrupt the underlying rhythm.
Junctional escape beats typically occur when a cardiac rhythm is too slow and a backup pacemaker site initiates an electrical impulse.
It is fairly common that a Junctional Escape Beat will occur as the first complex to terminate Sinus Arrest

This early impulse causes an early cardiac complex which disrupts the underlying rhythm.
The locus of stimulation being different, results in a change in the morphology of the P wave (inverted if it can be seen).
PJC ECG’s can occur occasionally or frequently.
PJC’s can be observed with or without a pattern
The P wave with PJC’s may occur before or after the QRS complex or be buried within the QRS.

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