Accelerated junctional rhythm
Also calledaccelerated junctional · nonparoxysmal junctional tachycardia · AJR
Definition
A junctional rhythm faster than the junctional escape rate (about 40 to 60 bpm) but not fast enough to be called junctional tachycardia, conventionally 60 to 100 bpm (the 2015 ACC/AHA/HRS SVT guideline, which calls it nonparoxysmal junctional tachycardia, gives 70 to 130 bpm). It arises from automaticity or triggered activity in the AV junction. The QRS complexes are narrow and resemble the sinus QRS, with absent P waves, retrograde P waves (inverted in II, III and aVF, within or after the QRS or just before it with a short PR), or sinus P waves that run independently of the QRS (AV dissociation).
Clinical noteDigoxin toxicity and myocardial infarction are classic causes.
Sources
- Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia. Circulation. 2016;133(14):e506-e574. doi.org/10.1161/CIR.0000000000000311
- Ashkanani AA, Ashkanani AH, Alkandari MF, et al. An accessible algorithm for the quick and precise interpretation of atrioventricular blocks in electrocardiograms. Ann Noninvasive Electrocardiol. 2026;31(4):e70207. doi.org/10.1111/anec.70207
- Samesima N, God EG, Kruse JCL, et al. Brazilian Society of Cardiology guidelines on the analysis and issuance of electrocardiographic reports - 2022. Arq Bras Cardiol. 2022;119(4):638-680. doi.org/10.36660/abc.20220623
- Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay. Circulation. 2019;140(8):e382-e482. doi.org/10.1161/CIR.0000000000000628
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.