Lesson 14 of 21 · Rhythm Recognition
Junctional Rhythms
When the AV junction paces the heart, the ventricles depolarize normally (narrow QRS) but the atria are activated backward (inverted or absent P waves).
01By rate
- Junctional escape: 40–60
- Accelerated junctional: 60–100 (digoxin toxicity, post-cardiac surgery, inferior MI)
- Junctional tachycardia: > 100
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Clinical pearl. Regularized ventricular response in a patient with known AFib on digoxin = accelerated junctional rhythm from digoxin toxicity.
Key takeaways
- Narrow QRS + inverted/absent P
- Escape rate 40–60
- Think digoxin when accelerated