Junctional Rhythm Follow-up

  • Author: Sean C Beinart, MD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD   more...
 
Updated: Dec 15, 2010
 

Further Inpatient Care

  • AV nodal junctional rhythms generally are well tolerated; however, bradycardia for prolonged periods often causes symptoms such as dizziness and presyncope or, rarely, frank syncope in younger patients. Patients with coronary artery disease, those with significant comorbidities, or elderly patients may not tolerate a secondary junctional rhythm well and, in the acute setting, may require intervention such as a pacemaker.
  • Currently, the choices of treatment strategy include determination of the underlying cause and whether it is a normal physiologic response (ie, that observed in a young athlete) or due to a primary cardiac abnormality such as heart block.
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Further Outpatient Care

Most of the workup on an otherwise healthy patient can be completed in an outpatient setting. Documentation of the arrhythmia on a rhythm strip is essential to properly diagnose the rhythm and to help exclude other causes.

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Complications

  • Complications are usually limited to symptoms such as dizziness, dyspnea, or presyncope.
  • Accidental injury may result from syncope if the arrhythmia is not tolerated well.
  • Exacerbation of cardiac comorbidities, such as congestive heart failure and rate-related cardiac ischemia, may occur.
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Prognosis

  • No evidence suggests increased mortality.
  • Prognosis is good.
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Contributor Information and Disclosures
Author

Sean C Beinart, MD, FACC, FHRS  Electrophysiologist, Cardiac Associates, PC

Sean C Beinart, MD, FACC, FHRS is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Alan D Forker, MD  Professor of Medicine, University of Missouri at Kansas City School of Medicine; Director, Outpatient Lipid Diabetes Research, MidAmerica Heart Institute of St Luke's Hospital

Alan D Forker, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, American Society of Hypertension, and Phi Beta Kappa

Disclosure: Research Grant Grant/research funds Hospital contracts to do research; I am a hospital employee with no personal profit; Speakers Bureau Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Steven J Compton, MD, FACC, FACP  Director of Cardiac Electrophysiology, Alaska Heart Institute, Providence and Alaska Regional Hospitals

Steven J Compton, MD, FACC, FACP is a member of the following medical societies: Alaska State Medical Association, American College of Cardiology, American College of Physicians, American Heart Association, American Medical Association, and Heart Rhythm Society

Disclosure: Nothing to disclose.

Amer Suleman, MD  Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital

Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

Chief Editor

Jeffrey N Rottman, MD  Professor of Medicine and Pharmacology, Director, Clinical Cardiac Electrophysiology Fellowship Program, Vanderbilt University School of Medicine; Chief, Department of Cardiology, Nashville Veterans Affairs Medical Center

Jeffrey N Rottman, MD is a member of the following medical societies: American Heart Association and North American Society of Pacing and Electrophysiology (NASPE)

Disclosure: Nothing to disclose.

References

  1. Kim D, Shinohara T, Joung B, Maruyama M, Choi EK, On YK. Calcium dynamics and the mechanisms of atrioventricular junctional rhythm. J Am Coll Cardiol. Aug 31 2010;56(10):805-12. [Medline].

  2. Deal BJ, Wolff GS, Gelband H. Current Concepts in Diagnosis and Management of Arrhythmias in Infants and Children. New York, NY: Futura Publishing; 1998:73-5.

  3. Josephson ME. Clinical Cardiac Electrophysiology. 4th ed. Baltimore, Md: Williams & Wilkins; 2008.

  4. Libby P, Bonow RO, Mann DL, Zipes, DP. Specific arrhythmias: diagnosis and treatment. In: Braunwald E, ed. Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa: WB Saunders; 2007:640-5.

  5. Daubert JP, Rosero SZ, Corsello A. Tachycardias. In: Rakel RE, Bope ET, eds. Conn's Current Therapy. New York, NY: WB Saunders; 2001:286-95.

 
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Junctional bradycardia due to profound sinus node dysfunction. No atrial activity is apparent.
Note the retrograde P waves that precede each QRS complex.
Accelerated junctional rhythm is present in this patient. Note the inverted P waves that precede each QRS complex, with a rate of 115 bpm.
 
 
 
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