Junctional tachycardia electrocardiogram

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

A 12 lead EKG should be obtained to evaluate the rhythm. In so far as it may alter treatment, any co-existing rhythm disturbance that may have precipitated junctional tachycardia should be ascertained such as

• Digitalis toxicity.
• ST elevation MI

• The rate is >60 beats per minute
• The rate is generally regular
• The QRS complex is narrow
• Retrograde p waves may be present due to retrograde conduction from the AV node. The p waves will be inverted in leads II and III.
• The p wave may be buried within the QRS complex and may not be discernable
• AV nodal reentry tachycardia (AVNRT) should be excluded.

Shown below is an EKG depicting junctional tachycardia (rate about 115/min), dissociated from a slightly slower sinus tachycardia (rate about 107/min) producing one form of double tachycardia; pairs of ventricular capture (C) beats (5th, 6th, 19th, and 20th beats); see laddergram.

Image obtained courtesy of Jason E. Roediger, CCT,CRAT

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