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AV junctional rhythm

MedGen UID:
68556
•Concept ID:
C0232208
•
Pathologic Function
Synonym: Nodal rhythm
SNOMED CT: AV junctional rhythm (11849007); Nodal rhythm (11849007); Atrioventricular junctional rhythm (11849007); Junctional rhythm (11849007)

Definition

An electrocardiographic finding of a rhythm which originates in the AV junction and results in a normal heart rate. It is characterized by retrograde P waves which may be obscured by or may follow the QRS complexes. The QRS complexes may be narrow or may demonstrate aberration. (CDISC) [from NCI]

Professional guidelines

PubMed

The challenge of fetal dysrhythmias: echocardiographic diagnosis and clinical management.
D'Alto M, Russo MG, Paladini D, Di Salvo G, Romeo E, Ricci C, Felicetti M, Tartaglione A, Cardaropoli D, Pacileo G, Sarubbi B, Calabrò R
J Cardiovasc Med (Hagerstown) 2008 Feb;9(2):153-60. doi: 10.2459/JCM.0b013e3281053bf1. PMID: 18192808
Management of atrial fibrillation in patients with heart failure.
Stevenson WG, Tedrow U
Heart Rhythm 2007 Mar;4(3 Suppl):S28-30. Epub 2006 Dec 6 doi: 10.1016/j.hrthm.2006.12.003. PMID: 17336880
The differential diagnosis of bigeminal rhythms.
Wing JP, Phibbs B
Heart Lung 1977 Nov-Dec;6(6):995-1004. PMID: 244329

Recent clinical studies

Etiology

AV-node isolation as an alternative to AV-node ablation in patients undergoing pace & ablate strategy.
Lemke L, El Hamriti M, Braun M, Baridwan N, Sciacca V, Fink T, Khalaph M, Guckel D, Eitz T, Sohns C, Sommer P, Imnadze G
J Cardiovasc Electrophysiol 2022 Dec;33(12):2606-2613. Epub 2022 Oct 19 doi: 10.1111/jce.15699. PMID: 36218022
Transesophageal atrial pacing for intraoperative sinus bradycardia or AV junctional rhythm: feasibility as prophylaxis in 200 anesthetized adults and hemodynamic effects of treatment.
Atlee JL 3rd, Pattison CZ, Mathews EL, Hedman AG
J Cardiothorac Vasc Anesth 1993 Aug;7(4):436-41. doi: 10.1016/1053-0770(93)90166-i. PMID: 8400099
Early rhythm disorders after arterial switch and intraatrial repair in infants with simple transposition of the great arteries.
Thies WR, Breymann T, Kleikamp G, Knobl H, Crespo-Martinez E, Matthies W, zu Knyphausen E, Meyer H, Körfer R
Thorac Cardiovasc Surg 1991 Dec;39 Suppl 2:190-3. doi: 10.1055/s-2007-1020017. PMID: 1788857
Effects of hyperkalemia on the electrocardiogram of patients receiving digitalis.
Weizenberg A, Class RN, Surawicz B
Am J Cardiol 1985 Apr 1;55(8):968-73. doi: 10.1016/0002-9149(85)90728-3. PMID: 3984884
Prevalence of ECG findings in 18-19 year old Swedish men.
Atterhög JH, Furberg B, Malmfors V, Kaijser L
Scand J Clin Lab Invest 1980;40(7):675-81. doi: 10.1080/00365518009091981. PMID: 7466297

Diagnosis

AV-node isolation as an alternative to AV-node ablation in patients undergoing pace & ablate strategy.
Lemke L, El Hamriti M, Braun M, Baridwan N, Sciacca V, Fink T, Khalaph M, Guckel D, Eitz T, Sohns C, Sommer P, Imnadze G
J Cardiovasc Electrophysiol 2022 Dec;33(12):2606-2613. Epub 2022 Oct 19 doi: 10.1111/jce.15699. PMID: 36218022
Wavelet leader multifractal analysis of heart rate variability in atrial fibrillation.
Gadhoumi K, Do D, Badilini F, Pelter MM, Hu X
J Electrocardiol 2018 Nov-Dec;51(6S):S83-S87. Epub 2018 Aug 23 doi: 10.1016/j.jelectrocard.2018.08.030. PMID: 30177367Free PMC Article
Recrudescent digoxin toxicity treated with plasma exchange: a case report and review of literature.
Rajpal S, Beedupalli J, Reddy P
Cardiovasc Toxicol 2012 Dec;12(4):363-8. doi: 10.1007/s12012-012-9171-1. PMID: 22618329
Effect of adenosine and verapamil in catecholamine-induced accelerated atrioventricular junctional rhythm: insights into the underlying mechanism.
Lee KL, Chun HM, Liem LB, Sung RJ
Pacing Clin Electrophysiol 1999 Jun;22(6 Pt 1):866-70. doi: 10.1111/j.1540-8159.1999.tb06809.x. PMID: 10392383
Trifascicular block with asynchronous intraventricular recovery and "supernormal" AV conduction.
Oreto G, Satullo G, Luzza F, Carerj S, Arrigo F, Schamroth L
J Electrocardiol 1989 Jul;22(3):257-61. doi: 10.1016/0022-0736(89)90037-x. PMID: 2760560

Therapy

AV-node isolation as an alternative to AV-node ablation in patients undergoing pace & ablate strategy.
Lemke L, El Hamriti M, Braun M, Baridwan N, Sciacca V, Fink T, Khalaph M, Guckel D, Eitz T, Sohns C, Sommer P, Imnadze G
J Cardiovasc Electrophysiol 2022 Dec;33(12):2606-2613. Epub 2022 Oct 19 doi: 10.1111/jce.15699. PMID: 36218022
Recrudescent digoxin toxicity treated with plasma exchange: a case report and review of literature.
Rajpal S, Beedupalli J, Reddy P
Cardiovasc Toxicol 2012 Dec;12(4):363-8. doi: 10.1007/s12012-012-9171-1. PMID: 22618329
Effect of adenosine and verapamil in catecholamine-induced accelerated atrioventricular junctional rhythm: insights into the underlying mechanism.
Lee KL, Chun HM, Liem LB, Sung RJ
Pacing Clin Electrophysiol 1999 Jun;22(6 Pt 1):866-70. doi: 10.1111/j.1540-8159.1999.tb06809.x. PMID: 10392383
Intravenous administration of diltiazem in the treatment of supraventricular tachyarrhythmias.
Boudonas G, Lefkos N, Efthymiadis AP, Styliadis IG, Tsapas G
Acta Cardiol 1995;50(2):125-34. PMID: 7610735
Effects of hyperkalemia on the electrocardiogram of patients receiving digitalis.
Weizenberg A, Class RN, Surawicz B
Am J Cardiol 1985 Apr 1;55(8):968-73. doi: 10.1016/0002-9149(85)90728-3. PMID: 3984884

Prognosis

Early rhythm disorders after arterial switch and intraatrial repair in infants with simple transposition of the great arteries.
Thies WR, Breymann T, Kleikamp G, Knobl H, Crespo-Martinez E, Matthies W, zu Knyphausen E, Meyer H, Körfer R
Thorac Cardiovasc Surg 1991 Dec;39 Suppl 2:190-3. doi: 10.1055/s-2007-1020017. PMID: 1788857

Clinical prediction guides

AV-node isolation as an alternative to AV-node ablation in patients undergoing pace & ablate strategy.
Lemke L, El Hamriti M, Braun M, Baridwan N, Sciacca V, Fink T, Khalaph M, Guckel D, Eitz T, Sohns C, Sommer P, Imnadze G
J Cardiovasc Electrophysiol 2022 Dec;33(12):2606-2613. Epub 2022 Oct 19 doi: 10.1111/jce.15699. PMID: 36218022
Wavelet leader multifractal analysis of heart rate variability in atrial fibrillation.
Gadhoumi K, Do D, Badilini F, Pelter MM, Hu X
J Electrocardiol 2018 Nov-Dec;51(6S):S83-S87. Epub 2018 Aug 23 doi: 10.1016/j.jelectrocard.2018.08.030. PMID: 30177367Free PMC Article
Prolonged transient atrial electrical silence following termination of chronic atrial tachyarrhythmias.
Turitto G, Saponieri C, Onuora A, El-Sherif N
Pacing Clin Electrophysiol 2007 Nov;30(11):1311-5. doi: 10.1111/j.1540-8159.2007.00863.x. PMID: 17976091
Early rhythm disorders after arterial switch and intraatrial repair in infants with simple transposition of the great arteries.
Thies WR, Breymann T, Kleikamp G, Knobl H, Crespo-Martinez E, Matthies W, zu Knyphausen E, Meyer H, Körfer R
Thorac Cardiovasc Surg 1991 Dec;39 Suppl 2:190-3. doi: 10.1055/s-2007-1020017. PMID: 1788857
Familial sinus node disease and degenerative myopia--a new hereditary syndrome?
Onat A
Hum Genet 1986 Feb;72(2):182-4. doi: 10.1007/BF00283944. PMID: 3943873

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