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      Junctional Escape Rhythm in the Sick Sinus Syndrome



      S. Karger AG

      Junctional arrest, Asystolic pause duration

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          In 21 patients with and 31 without junctional escape beats, a comparison of the symptoms, revealed that there were no significant differences (p > 0.05) in the symptoms between these two groups manifesting a sick sinus syndrome. Thus, the occurrence of junctional escape beats did not provide the anticipated shortening of the asystolic pauses to prevent the occurrence of symptoms related to the period of electrical silence. In 7 patients with an escape junctional rhythm, the long pause was interrupted by the occurrence of a regular junctional rhythm. The pause was not preceded by a supraventricular tachycardia, ruling out physiologic overdrive suppression of the junctional pacemaker. The period of asystole preceding the junctional rhythm was not multiple of the R-R interval of the junctional rhythm. 4 additional patients demonstrated long periods of asystole, uninterrupted by junctional escape beats and at other times exhibited shorter pauses which were terminated by junctional escape beats. These findings can be explained by the presence of a ‘junctional arrest’ which is analogous to sinoatrial arrest. The phenomenon of ‘junctional arrest’ may be one tenable explanation to account for the lack of protection by junctional escape activity against the symptoms associated with the sick sinus syndrome.

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          Author and article information

          S. Karger AG
          31 October 2008
          : 63
          : 4
          : 193-198
          Departments of Medicine, Maimonides Medical Center and State University of New York, Downstate Medical Center, Brooklyn, N.Y.; Booth Memorial Medical Center, Flushing, N.Y., and New York University School of Medicine, New York, N.Y.
          169897 Cardiology 1978;63:193–198
          © 1978 S. Karger AG, Basel

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          Pages: 6
          Original Paper


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