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In junctional rhythm, the SA node is no longer in control and the AV node becomes the pacemaker by default due to the property of automaticity. Because the AV node is a less reliable pacemaker, the development of junctional rhythm is cause for concern. The analysis of junctional rhythms is determined by the P waves and the rate.
Because the impulse starts in the AV node, the atria are depolarized in a retrograde manner resulting in an inverted P wave in the upright (positive) leads (such as lead II).
Analysis of inverted P waves (in the upright leads)
Analysis of rate
Junctional rhythm. HR=52 BPM. QRS=0.08.
Accelerated junctional rhythm. HR=58 BPM. QRS=0.08.
Junctional tachycardia. HR=115 BPM. QRS=0.08.
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