What Is Junctional Escape Rhythm?

A junctional escape rhythm is when the heartbeat starts in a different part of the heart than it should. This type of arrhythmia may not need treatment, but a doctor does need to investigate the underlying causes.

When the heart beats, it follows a specific pattern. An electrical signal starts in a specific node and moves through the organ in a set pathway.

When the signal starts in a part of the heart called the atrioventricular junction, it’s called a junctional rhythm. One type of junctional rhythm is a junctional escape rhythm.

These changes in how the heart beats can happen because of an underlying medical condition or a medication you’re taking. It doesn’t always need treatment, but a doctor should investigate what may be causing the phenomenon. Sometimes, a pacemaker or another intervention can help resolve the underlying issue.

What is junctional escape rhythm?

Electrical signals in the heart allow the organ to beat. These signals typically start at the bottom of the heart and move to the top, causing muscle contractions and the movement of blood through the heart.

The signals start at the upper chambers (atria) of the heart and move toward the bottom chambers (ventricles).

In a junctional rhythm, the heartbeat doesn’t start at the SA node. Instead, it starts at the AV node or His bundle. The His bundle is a collection of heart muscle cells located at the junction of the ventricles and the atria (atrioventricular junction).

There are different types of junctional rhythm, and these are defined by the number of beats per minute. A junctional escape rhythm is a junctional rhythm of 40 to 60 beats per minute (bpm).

Other types of junctional rhythm include:

• Junctional bradycardia: This is characterized by fewer than 40 bpm.
• Accelerated junctional rhythm: This is characterized by 60 to 100 bpm .
• Junctional tachycardia: This is characterized by more than 100 bpm.

A junctional escape rhythm, like all conditions where there is a change in the location of the natural pacemaker of the heart, is a type of arrhythmia .

What are the symptoms of junctional escape rhythm?

A junctional escape rhythm might not cause symptoms. If symptoms do occur, they might be connected to the underlying cause of the condition.

Symptoms might arise only in isolated circumstances . Emotional or physical stress, for example, might cause you to experience symptoms connected to the junctional escape rhythm.

You might experience:

• a change in your heart rate
• heart palpitations
• dizziness
• lightheadedness
• extreme fatigue
• shortness of breath
• fainting
• chest discomfort
• chest pain
• trouble breathing during sleep

What can cause junctional escape rhythm?

A junctional rhythm happens when the SA node is blocked. The AV node and His bundle are automatic pacemakers that naturally take over. It can be a common response to high vagal tone, such as during sleep or in well-trained athletes.

However, many medical conditions and medications can lead to SA node dysfunction and junctional rhythm.

Conditions

A wide range of medical conditions can lead to SA node dysfunction. They include:

• chest trauma
• myocarditis
• hypothyroidism
• sleep apnea
• Lyme disease
• rheumatic fever

There are many other medical causes, including other cardiovascular conditions. Some medical treatments, such as radiation therapy and endotracheal suctioning , can also cause a junctional rhythm.

Medications

Many prescription and nonprescription drugs can also lead to SA node dysfunction, including:

• beta-blockers
• calcium channel blockers
• clonidine
• cimetidine
• lithium
• amitriptyline
• opioids
• cannabinoids

What are the risk factors associated with junctional escape rhythm?

The risk factors for a junctional rhythm depend on the underlying causes. Some conditions that lead to a junctional rhythm are more likely to occur later in life, such as sick sinus syndrome, the risk of which increases with age .

Being at risk of certain medical conditions — such as hypothyroidism, heart and blood vessel conditions, or sleep apnea — can also increase your risk of developing a junctional escape rhythm.

How do doctors diagnose junctional escape rhythm?

To diagnose a junctional rhythm, a doctor will perform a physical exam, ask about your medical history, and run tests. They might also perform a physical examination, check your vital signs, and evaluate your :

• respiration rate
• blood pressure
• heart rate
• current medications
• thyroid functioning
• lung (pulmonary) functioning

A doctor is likely to perform an ECG to take a closer look at your heart rhythm. The results can indicate if the AV node is starting the heartbeat instead of the SA node and confirm if the heart rate is at 40 to 60 bpm.

Treatment options

A junctional escape rhythm doesn’t always need treatment, but treatment may be necessary for the underlying cause of the condition.

If the condition is the result of sick sinus syndrome, for example, a doctor might recommend inserting a pacemaker . A pacemaker is a device implanted in the body to help the heart beat at a normal rate.

A doctor might also recommend adopting a heart-healthy lifestyle to keep your heart healthy. This includes eating a heart-healthy diet and increasing your physical activity.

Managing the underlying condition that led to the junctional escape rhythm might also form part of a treatment plan.

Takeaway

A junctional escape rhythm is a form of arrhythmia. It occurs when your heartbeat starts at the AV node or His bundle of the heart instead of the SA node. A junctional escape rhythm maintains a rate of between 40 and 60 bpm.

Many medications and medical conditions can affect the function of the SA node and result in a junctional escape rhythm.

The condition might not need treatment, but a doctor might recommend caring for your heart health to keep your heart healthy.