Junctional Rhythm

- In pts with sinus bradycardia, SA node exit block or AV block, junctional escape beats may occur, usually at a rate between 40-60 beats/min, depending on the level of the rescue pacemaker within the conduction system. Junctional escape beats may conduct retrogradely into the atria, but the QRS complex usually will mask any retrograde P wave. If the ventricular rate is too slow, myocardial or cerebral ischemia may develop.


ED Care and Disposition

  1. Isolated, infrequent junctional escape beats usually do not require specific treatment.
  2. If sustained junctional escape rhythms are producing symptoms, treat the underlying cause
  3. In unstable pt, give atropine 0.5 mg IV q 5 min to a total of 2 mg. This will accelerate the SA note discahrge rate and enhance AV nodal conduction.
  4. Use transcutaneous or transvenous pacing in unstable pts not responsive to atropine.
  5. Manage pts with digoxin toxicity as discussed in SVT.