Treatment of the junctional rhythm is usually not necessary, but treatment of the underlying problem (e.g., underlying sinus or atrial bradycardia) may be needed. These symptoms (which can be vague and easily missed) include lightheadedness, palpitations, effort intolerance, chest heaviness, neck tightness or pounding, shortness of breath, and weakness. Junctional rhythm can cause symptoms due to bradycardia and/or loss of AV synchrony. Junctional rhythm usually is associated with a benign course, but it can cause symptoms due to AV dyssynchrony (pseudo “pacemaker syndrome”). It can also be seen as part of tachy-brady syndrome. It can be caused by necessary medications (e.g., β-adrenergic blockers, verapamil, digitalis, sotalol, amiodarone). Junctional rhythm can be due to hypokalemia, MI (usually inferior), cardiac surgery, digitalis toxicity (rare today), sinus node dysfunction, or after ablation for AV node reentrant tachycardia. Because the atrial and QRS rhythms are independent, AV dissociation will be present capture beats will document the absence of AV block as the cause of the AV dissociation. 3.15), with its usual rate of 40 to 60 bpm being exceeded, particularly with adrenergic stimuli. Junctional rhythm can be an accelerated rhythm ( Fig. Holter monitoring may be useful to document the presence of sinus node dysfunction and the cause of any symptoms that might result from the rhythm.
The junctional rate is usually 40 to 60 bpm. P waves may be absent, or retrograde P waves (inverted in leads II, III, and aVF) either precede the QRS with a PR of less than 0.12 seconds or follow the QRS complex. Junctional rhythm is a regular narrow QRS complex rhythm unless bundle branch block (BBB) is present. Nora Goldschlager MD, in Arrhythmia Essentials (Second Edition), 2017 Junctional rhythm Description
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