Junctional Escape Beats and Rhythm

Rate	40-60/bpm
P wave	inverted in leads where they are normally upright; this happens when the atrial depolarization wave moves towards a negative (-) lead. See diagram above. P waves may occur before, during or after the QRS, depending on where the pacemaker is located in the AV junction.
QRS	normal
Conduction	P-R interval < .12 seconds if present.
Rhythm	irregular as a result of the escape beats.

The most common cause of this rhythm in healthy individuals is sinus bradycardia.

It may also be seen in the presence of a high degree or complete AV block. If the ventricular rate is slow, hemodynamic compromise may occur.

Treatment depends upon the underlying cause and the baseline dysrhythmias.

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With a junctional rhythm, P waves are inverted in leads where they are usually upright.