AV-junctional rhythm

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  1. AV-Junctional Rhythm

An **AV-junctional rhythm** is a type of cardiac rhythm that originates from the atrioventricular (AV) junction, which is the area of the heart located between the atria and the ventricles. This rhythm occurs when the electrical impulses that normally originate from the sinoatrial (SA) node are either absent or blocked, causing the AV node to take over as the pacemaker of the heart.

Pathophysiology[edit | edit source]

The AV node is a part of the cardiac conduction system that normally conducts electrical impulses from the atria to the ventricles. In an AV-junctional rhythm, the AV node or the surrounding tissue generates impulses at a rate typically between 40 to 60 beats per minute. This can occur due to:

  • **SA node dysfunction**: When the SA node fails to generate impulses, the AV node can assume the role of the pacemaker.
  • **Heart block**: In cases of complete heart block, the impulses from the SA node are blocked from reaching the ventricles, and the AV node may take over.
  • **Increased vagal tone**: Conditions that increase vagal tone can suppress the SA node, allowing the AV node to become the pacemaker.

Clinical Presentation[edit | edit source]

Patients with an AV-junctional rhythm may be asymptomatic or may present with symptoms related to bradycardia, such as:

  • Fatigue
  • Dizziness
  • Syncope
  • Palpitations

The rhythm is often identified on an electrocardiogram (ECG) by the following characteristics:

  • **Absent or inverted P waves**: P waves may be absent, inverted, or occur after the QRS complex.
  • **Narrow QRS complexes**: The QRS complexes are typically narrow, indicating that the ventricles are being depolarized normally.
  • **Regular rhythm**: The rhythm is usually regular with a rate of 40-60 beats per minute.

Diagnosis[edit | edit source]

Diagnosis of an AV-junctional rhythm is primarily made using an ECG. The key features to look for include the absence or inversion of P waves, narrow QRS complexes, and a regular rhythm.

Management[edit | edit source]

Management of AV-junctional rhythm depends on the underlying cause and the presence of symptoms. Treatment options may include:

  • **Observation**: In asymptomatic patients, no treatment may be necessary.
  • **Addressing underlying causes**: Treating conditions such as electrolyte imbalances or medication side effects.
  • **Pacemaker implantation**: In cases of symptomatic bradycardia or complete heart block, a pacemaker may be required.

Also see[edit | edit source]


Cardiovascular disease A-Z

Most common cardiac diseases

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Contributors: Prab R. Tumpati, MD