Junctional Rhythms?

[bobdust2008]

When a rhythm is considered to have been misconducted in the AV node and the AV junction has taken over the pacemaking responsibilities for the heart the P wave is oft inverted, or it's hidden in the QRS Complex or the QRS complex is upside down. This is what is stated in the Book "BASIC ARRHYTHMIAS". So you have a misconducted P WAve, a somewhat normal QRS complex in duration (.12-.20), and a somewhat normal Twave. My question isn't really a question. You have to take the rates into consideration with those other (QRS & T) intervals, and figure that there is a P WAve somewhere in there, or most commonly, obviously inverted preceding the QRS COmplex, but if it's not, or you may get a diphasic QRS or T, How can you not mistake this for possible slow A-Fib, if the rate was between like 20-60, because of P-waves being conducted in an A-Fib, but what if they are just slowly fibrillating, or mistaken for that, what would happen. I mean you have a PT. who is in A-fib at a moderately slow rate, and there aren't many fibrillatory waves but it appears to have a conducted P, as a fibrillatory wave that is within normal measurements, yet the rate is slow. Oh wait I just answered it, There is a something different about these 2 rhythms. A slow Junctional Escape would not have regular P waves.? they'd be regularly? or Irregularly hidden in the underlying rhythm?  


This discussion is related to arrhythimias on planes.