Junctional escape rhythm
Also calledjunctional escape · nodal escape rhythm · AV junctional escape
Definition
A rhythm from the AV junction that takes over as an escape rhythm when the sinus impulse fails or does not reach the ventricles, as in sinoatrial block or high-grade or complete AV block. Its rate is about 40 to 60 bpm (some definitions use under 50 bpm). The QRS complexes match the patient's usual conducted QRS: usually narrow (under 120 ms), but wide if a bundle branch block is already present. P waves are absent, or inverted in the inferior leads (II, III, aVF) just before the QRS with a short PR interval, hidden within it, or just after it; when the escape follows complete AV block, the sinus P waves continue independently (AV dissociation).
Sources
- 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
- Loewenstein I, Yagel O, Shrem M, et al. Electrocardiographic characteristics of escape rhythm during complete atrioventricular block after transcatheter aortic valve replacement. Rev Cardiovasc Med. 2026;27(1):43915. doi.org/10.31083/RCM43915
- 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
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.