Junctional Escape Rhythm

What is junctional escape rhythm?

A junctional escape rhythm starts in a place farther down your heart’s electrical pathway than it should. The command to beat normally starts in your sinoatrial node (SA node) and works its way down through your heart. When your SA node is hurt and can’t start a heartbeat (or one that’s strong enough), your heartbeats may start lower down in your atrioventricular node or at the junction of your upper and lower chambers.

These areas usually get the signal after it comes down from the SA node, but with junctional escape rhythm, it’s like the train conductor at the first stop is asleep. The conductor from a later stop takes over giving commands for your heart to beat. It’s not their normal job, but they can fill in for your “sleeping conductor” and keep your heart going. The heartbeat they create isn’t quite the same, though. Instead of a normal heart rate of 60 to 100 beats per minute, a junctional escape rhythm rate is 40 to 60 beats a minute.

Who does junctional escape rhythm affect?

One out of every 600 Americans older than 65 with a heart problem has something wrong with their sinus node. With this issue, it’s common to get junctional rhythm.

Other people who get junctional rhythms include:

• Athletes.
• Children.
• People who have sick sinus syndrome.

What are the symptoms?

You may not have any symptoms of junctional escape rhythm. If you do have symptoms, they may include:

• Feeling very tired.
• Fainting.
• Feeling dizzy or lightheaded.
• Having palpitations.

What causes junctional escape rhythm?

Numerous conditions and medicines can stop your sinoatrial node from sending electrical signals that start your heartbeat.

Some conditions or treatments that can cause junctional escape rhythm

• Sleep apnea, which makes you stop breathing while sleeping.
• Radiation therapy.
• Heart attack.
• Myocarditis, or inflammation of your heart muscle.
• Pericarditis, or inflammation in the sac around your heart.
• Trauma to your chest.
• Lyme disease.

Some medicines that can cause junctional escape rhythm

• Lithium.
• Beta blockers.
• Opioids.
• Adenosine.
• Clonidine (Catapres® or Kapvay®).

How is junctional escape rhythm diagnosed?

Your healthcare provider will do a physical exam and ask for your medical history.

They’ll also do:

• Electrocardiogram (EKG).
• Blood tests.
• Echocardiogram.

How is junctional escape rhythm treated?

People who are healthy and don’t have symptoms don’t need treatment.

Depending on the cause, others with symptoms may need:

• Medicine such as atropine (Atreza® or Sal-Tropine®).
• Catheter ablation to make scars to stop abnormal electrical signals in your heart.
• Temporary external pacemaker.
• Permanent pacemaker, possibly before middle age.

Complications of the treatment

Although getting a pacemaker is usually a safe procedure, some people can have problems afterward. Complications can include:

• Infection.
• Blood clots.
• Scars around your pacemaker.
• Problems with the device’s wires getting out of place.

How long does it take to recover from this treatment?

You can go back to your regular activities a few days after you get a pacemaker, but you’ll need to wait a week to lift heavy things or drive.

How can I reduce my risk?

Many medical conditions (See Causes and Symptoms section) can cause junctional escape rhythm. Some of these conditions may be easier than others to avoid. However, if a specific drug is causing your junctional escape rhythm, your healthcare provider can look for an alternative drug that doesn’t cause this problem.

What can I expect if I have junctional escape rhythm?

The outlook for junctional escape rhythm is good. Your symptoms should go away after you have treatment or change medications.

How do I take care of myself?

With junctional escape rhythm, your healthcare provider’s focus will most likely be on the condition that’s causing it. Based on what condition or medication caused the problem, you may need to take a different medication or get the treatment your provider recommends.

When should I seek care?

If you get a pacemaker, you’ll see your healthcare provider a month afterward. Then you’ll keep having follow-up appointments once or twice a year. You should contact your provider if you think your pacemaker isn’t working or you have an infection.

What questions should I ask my doctor?

• Do I need treatment for junctional escape rhythm?
• What’s causing my junctional escape rhythm?
• Will I get junctional escape rhythm again if I get the condition that caused it again?

A note from Cleveland Clinic

If your healthcare provider finds a junctional escape rhythm and you don’t have symptoms, you probably won’t need treatment. However, if you have this diagnosis and symptoms, your provider will most likely focus on the condition that’s causing it. Consider your treatment options and ask questions if there’s anything that isn’t clear. Then, keep taking your medicines and going to follow-up appointments with your provider.