Atrioventricular Junctional Escape Research Articles

Expert consensus document on automated diagnosis of the electrocardiogram: The task force on automated diagnosis of the electrocardiogram in Japan. Part 1: Nomenclature for diagnosis and abnormal findings.

As these terms should accurately represent the abnormal findings and conditions as much as possible, we propose to unify these terms into terminologies that are not confusing and easy to understand for everyone.

Apparent AV junctional escape in Wenckebach AV block: markedly slow conduction through the slow AV pathway

We report here two cases of Wenckebach atrioventricular (AV) block in which apparent AV junctional escape was observed, but most likely resulted from markedly slow conduction through the slow pathway of dual AV junctional pathways. In these cases, it seems that a blocked P-wave was followed by an AV junctional escape beat. However, a blocked P-wave occasionally failed to be followed by an escape beat, and the RR interval containing the blocked P-wave was markedly longer than the above escape interval. In one case, apparent AV junctional escape beats with aberrant ventricular conduction were found, and QRS complexes of the same configuration were also found without the preceding ventricular pause. This strengthens the possibility that apparent AV junctional escape occurred because of markedly slow conduction through the slow AV pathway.

Manifest and concealed AV nodal reentry in wenckebach type of AV conduction with AV junctional escape rhythm

An electrocardiogram was obtained that was characterized by sinus rhythm with progressive prolongation of the PR interval not followed by a blocked sinus impulse. After a critically long PR interval, the QRS complex was followed by a premature P′ wave, representing an echo beat, a manifest reentry in the atrioventricular (AV) node. The pause, occasioned by the premature P′ wave, was at times interrupted by an AV junctional escape beat, occurring with an escape interval of 1.21–1.24 seconds. On other occasions, however, the escape beat did not manifest on schedule, even though the pause was markedly longer than the escape cycle. This suggested that the manifest reentry was followed by a further concealed reentry, resulting in inapparent discharge of the AV junctional escape pacemaker, whose firing was postponed, thereby allowing the sinus impulse to capture the ventricles.

Resin Hemoperfusion in Acute Digoxin Intoxication

<h3>To the Editor.—</h3> Acute intoxication with large amounts of digoxin is associated with an appreciable mortality of 20% to 25% despite good supportive care.¹Successful management depends on rapid reduction of serum digoxin concentration. Although poorly removed by hemodialysis, digoxin has been shown to be effectively removed experimentally by hemoperfusion over charcoal or lipophilic resins.^2,3 We have successfully used hemoperfusion over a resin (Amberlite XAD-4) to treat a 40-year-old physician who had taken one hundred 0.5-mg digoxin tablets in a suicide attempt three hours before admission. Repeated gastric lavage was performed, and some particulate matter was recovered from the stomach. The initial 12-lead standard ECG showed normal sinus rhythm with first degree atrioventricular (AV) block and ST sagging in V₄to V₆; however, continuous monitoring soon showed frequent sinus pauses and slow AV junctional escape beats. Because of the massive amount of digoxin purportedly ingested and