Junctional rhythm
Also callednodal rhythm · AV junctional rhythm
Definition
A rhythm arising from the AV junction (the AV node region and the bundle of His) rather than the sinus node, with QRS complexes similar to the patient's usual conducted QRS, so they are narrow (under 120 ms) unless a bundle branch block coexists. If the atria are activated backward (retrograde conduction), the P waves are inverted in the inferior leads (II, III, aVF) and fall just before the QRS with a short PR interval, are hidden within it, or follow it; alternatively the sinus node may keep driving the atria independently (AV dissociation). The term is a general label covering junctional escape rhythm, accelerated junctional rhythm, and junctional tachycardia, which are named by rate.
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
Last reviewed 2 October 2026. Every definition in the EKG Dictionary cites the guideline, consensus statement or original paper it comes from.