![]() It can also occur when there is a pathologically high junctional or ventricular rate such as ventricular tachycardia (VT) with absence of retrograde VA conduction. This requires absence of retrograde VA conduction, otherwise the ‘downstream’ rhythm would capture the sinus node. ![]() 1, 2 AV dissociation can occur with slowing of the physiological pacemaker as occurs in the setting profound sinus bradycardia with a junctional escape rhythm or VVO/VVI pacing in a patient with sinus node dysfunction. However, AV dissociation, in which two separate rhythms exist concurrently within the heart, can occur in other conditions. (B) The patient’s baseline ECG.ĪV dissociation is most commonly associated with third-degree or complete AV block. A transthoracic echocardiogram performed at the time revealed normal left ventricular size and systolic function with no regional wall motion abnormalities and no significant valvular disease.įigure 1: (A) Electrocardiogram (ECG) on presentation demonstrating an accelerated junctional rhythm with isorhythmic atrioventriculardissociation. A repeat ECG ( Figure 1B) performed a few minutes later demonstrated sinus rhythm at 70 bpm with resting ST segment depression in the inferolateral leads. This represents an accelerated junctional rhythm with isorhythmic atrioventricular (AV) dissociation. A routine 12-lead electrocardiogram (ECG) ( Figure 1A) demonstrated a narrow complex regular rhythm at 78 bpm with visible P waves immediately following the QRS complexes superimposed on the ST segments. There was no history of cardiac disease in her past. She denied any recent symptoms of cardiac ischemia or failure. E-mail: ECG descriptionĪ 49-year-old woman presented to the Emergency Department with flu-like symptoms for the preceding 3 days. ![]() Manuscript received June 2, 2013, final version accepted June 28, 2013.Īddress correspondence to: Dr Adam Lee, Department of Cardiology, Liverpool Hospital Liverpool, NSW, Australia. The authors report no conflicts of interested for the published content. AV dissociation, electrocardiogram, junctional rhythm, retrograde P waves. AV Dissociation Masquerading as an Accelerated Junctional Rhythm with Retrograde Atrial ActivationĪDAM LEE, MBBS, MMed ( Clin Epi), DAVID RICHARDS, MD, FRACP, FACC and HANY DIMITRI, MBBS, PhD, FRACPĭepartment of Cardiology, Liverpool Hospital, Sydney, Australia ![]()
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