Junctional Rhythm

A cardiac rhythm originating from the AV junction

Definition

A junctional rhythm arises when the AV node (junction) takes over as the cardiac pacemaker, typically because the SA node fails or conduction is blocked. Rate is usually 40 to 60 bpm.

ECG Features

Narrow QRS complexes (normal ventricular conduction)
Absent, inverted, or retrograde P waves
If present, P waves may appear just before, during, or after the QRS

Types

Junctional escape rhythm: 40 to 60 bpm (default)
Accelerated junctional: 60 to 100 bpm
Junctional tachycardia: 100+ bpm

Causes

Sinus node dysfunction, inferior MI, digoxin toxicity, beta-blockers, calcium channel blockers, electrolyte imbalance.

Nursing Interventions

Assess symptoms, such as treat only if symptomatic (hypotension, poor perfusion, chest pain). Atropine, transcutaneous pacing, or pacemaker insertion. Evaluate for reversible causes (digoxin, electrolytes).

NCLEX Relevance

Junctional cues: narrow QRS, inverted/absent P waves.