Junctional Rhythm - Symptom, Causes, Treatment

A junctional rhythm occurs when the sinoa-trial node fails and the area around the atrioventricular junction takes over as the heart's pacemaker. Junctional rhythms are common in patients with sick sinus syndrome or in patients who have significant bradycardia that allows the atrioventricular nodal region to determine the heart rate. Changes in autonomic tone or the presence of sinus node disease that is causing an inappropriate slowing of the sinus node may exacerbate this rhythm. Young healthy individuals, especially those with increased vagal tone during sleep, are often noted to have periods of junctional rhythm that is completely benign, not requiring any intervention. Junctional escape rhythms, which are common in younger and athletic individuals during periods of increased vagal tone, occur equally in males and females. This rhythm may occur in persons of any age. A junctional rhythm may indicate underlying heart disease, such as coronary artery disease, acute myocardial infarction (especially in the inferior wall), or degenerative changes in the conduction system. If junctional rhythm is due to symptomatic sick sinus syndrome, permanent pacemaker implantation is indicated.

Causes of Junctional rhythm

The main causes of Junctional rhythm:

• Digoxin toxicity.
• Sick sinus syndrome (including drug-induced).
• Diphtheria.
• Other drugs (eg, beta-blockers, calcium blockers).
• Isoproterenol infusion.
• Metabolic states with increased adrenergic tone.

Signs and symptoms of Junctional rhythm

Signs and symptoms often experienced with Junctional rhythm are:

• Nausea.
• Diaphoresis.
• Fatigue.
• Dizziness.
• Shortness of breath.
• Chest pain.

Treatment of Junctional rhythm

Some most common treatmet of Junctional rhythm:

• The decision to treat a junctional rhythm depends on the underlying cause and the stability of the patient.
• In patients with complete AV block, high-grade AV block, or symptomatic sick sinus syndrome (ie, sinus node dysfunction), a permanent pacemaker may be needed.
• If the junctional rhythm is due to digitalis toxicity, then atropine, digoxin immune Fab, or both may be necessary.
• Surgery is sometimes done to interrupt abnormal electrical conduction. This is often combined with surgery to correct other heart abnormalities.

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