We need to be aware that the primary pacemaker of the heart is named the Sino-Atrial Node, SA node in short. This is the main pacemaker which produces an inherent heart rate of sixty to one hundred beats per minute. If this fails to produce an electrical impulse or some factor irritates the pacemaker foci below the Sino-Atrial Node’s level. Atrial pacemaker foci will follow with an inherent heart rate of sixty to eighty beats per minute, then if that fails, it goes to the Atrio-Ventricular Node (AV node) with an inherent rate of forty to sixty beats per minute, and ultimately if that fails it goes to ventricular foci with an inherent heart rate of twenty to forty beats per minute. With that knowledge in mind, it will help us differentiate between a premature atrial contraction, premature junctional contraction, and a premature ventricular …show more content…
According to Burns, a premature junctional complex is defined as a premature beat arising from an ectopic focus within the AV junction. Many factors can cause this ectopic beat. These can include: groups of pacemaker cells throughout the conducting system are capable of spontaneous depolarization, the rate of depolarization decreases from top to bottom: fastest at the sinoatrial node; slowest within the ventricles, ectopic impulses from subsidiary pacemakers are normally suppressed by more rapid impulses from above, however, if an ectopic focus depolarizes early enough – before the arrival of the next sinus impulse – it may “capture” the ventricles, producing a premature contraction (Burns). It is also important to be aware of the electrocardiograph features of PJCs. The following features are: narrow QRS complex, either without a preceding P wave or preceded by an abnormal P wave with a PR interval of < 120 ms (these “retrograde” P wave are usually inverted in leads II, III and aVF), occurs sooner than would be expected for the next sinus impulse, followed by a compensatory pause, PJCs that arrive early in the cycle may be conducted aberrantly , most commonly with a RBBB (right bundle branch block) morphology