Accelerated Junctional Rhythm

Heart rhythms are a very important thing. They are the rhythms in which our heart beats every minute, every hour, of every day. Your heart is made up of muscle around the size of your fist clenched up. It pumps blood out to your body day in and day out. It keeps all the organs oxygenated and fed the right nutrients and helps clean toxins out of your body. This is a lot of work to do, but it all depends on a healthy heart rhythm. Sometimes things can go wrong. This article will help you understand more about the accelerated junctional rhythm, how it is diagnosed, treated, and any complications that may arise from this condition.

What Is Accelerated Junctional Rhythm?

In the heart, the SA node (sinus node) is the primary pacemaker of the heartbeat. Something happens and the node stops working correctly so the AV node takes over as a protective measure. The heart rate that comes from the AV node is often slower than the normal pace of the SA node. The AV node usually only beats at 40 to 60 beats per minute, but in accelerated junctional rhythm the rate is faster than 60 beats per minute, but still slower than 100 beats per minute.

There are a few other types of junctional rhythms caused by the same malfunction in the AV node. These include:

  • Junctional Escape Rhythm – In this junctional rhythm the heart beats 40 to 60 beats per minute. It is caused things like too much potassium in the blood, sinus bradycardia (slow heart rate), digoxin poisoning, and drugs that slow the heart rate.
  • Junctional Tachycardia – This is a type of tachycardia (fast heart rate) caused by heart failure, digoxin toxicity, and the drug theophylline. In this condition, the heart beats faster than 100 bpm.
  • Premature Junctional Complex – These are heart beats that happen too early. It is basically a “hiccup” in the heart. They are very rare and most often benign.

What Causes Accelerated Junctional Rhythm?

There are several causes of accelerated junctional rhythm. These include:

  • Sick Sinus Syndrome (Abnormal Heart Rhythm)
  • Diptheria infection
  • Lyme disease
  • Rheumatic fever
  • Digoxin toxicity
  • Heart block
  • Drugs that change the heart rate
  • Disorders of metabolism

Symptoms of Accelerated Junctional Rhythm

Some people don’t ever feel any symptoms of accelerated junctional rhythm. Those who do have symptoms feel the following:

  • Fainting spells
  • Dizziness
  • Heart palpitations
  • Fatigue
  • Feeling lightheaded
  • Shortness of breath

If you have any of the above symptoms, contact your doctor.

What Does Accelerated Junctional Rhythm EKG Look Like?

The EKG is a test that checks the electrical system of the heart. The doctor places “leads” on the chest to look at the electrical activity. An EKG tracing that shows a junctional rhythm will often look like this:

Figure 1: Accelerated Junctional Rhythm     Source: EMT Resource

Figure 2: Normal EKG                         

As you can see in the above pictures, the EKG done on a patient with Accelerated Junctional Rhythm has a lot less “waves” than the normal EKG. This is because the electrical impulse is not firing from the right place in the heart.

EKG features of Accelerated Junctional Rhythm include:

How Is Accelerated Junctional Rhythm Treated?

Accelerated junctional rhythm is most often harmless and does not need any treatment in healthy people who are able to tolerate the symptoms. In those who need treatment, they include:

  • Pacemaker – If the cause is due to heart block, doctors may choose to implant a pacemaker to help regulate the heart rhythm. It isn’t good to shut down this protective rhythm so a pacemaker will just bypass it and make sure the heart does not beat too fast or too slow.
  • Supportive care – If you have to go to the emergency room, you will be monitored with EKGs, given oxygen, and have your blood pressure monitored.
  • Treatment of digoxin toxicity – Doctors can give medications to help bring digoxin levels down and treat the symptoms. They can give drugs like atropine, Digibind (removes digoxin), or the seizure drug phenytoin.
  • Ablation – In severe cases, doctors may need to insert a catheter into the heart and send a frequency to shut down the irregular rhythm.

Complications of Accelerated Junctional Rhythm

Accelerated junctional rhythm usually does not cause complications in healthy individuals. Most people can tolerate the symptoms and they don’t cause any further problems. Some people may have trouble with:

  • Bradycardia (slow heart rate)
  • Dizziness
  • Fainting
  • Need for pacemaker
  • Shortness of breath
  • Injuries from fainting
  • Worsening of heart conditions (Congestive Heart Failure, Cardiac Ischemia)

The prognosis for accelerated junctional rhythm is good if there are no underlying heart conditions and the person is healthy. Research shows that you most likely will not die from this condition, however if you have another heart problem it could increase the chances of death from other conditions. If you are found to have this irregular rhythm, see treatment with a cardiologist for an evaluation.

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