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ECG library

Junctional escape rhythm

core

A 70-year-old on diltiazem and digoxin, dizzy on the ward.

25 mm/s · 10 mm/mV · synthetic tracing
100%
IIIIIIaVRaVLaVFV1V2V3V4V5V6
II (rhythm)
Calipers:2000 ms50.0 small boxes30 bpm if R-RDrag the orange markers. One small box = 40 ms.

Key findings

  • Regular, narrow, 40 to 60 per minute
  • No consistent P before the QRS

Learning points

  • Escape rhythms are rescuers, never suppress the escape; treat the reason the sinus node failed.
  • Narrow escape means the block is high; a wide, slower escape means it is low and less reliable.

Connected