Reciprocal impulses of junctional origin causing trigeminy.
Praveen MurugesanSaurabh Kumar GuptaPublished in: BMJ case reports (2023)
Reciprocal impulses of junctional origin were seen in a patient with left isomerism who had undergone Kawashima repair in infancy. Heterotaxy syndromes are associated with disturbances in sinus node function. Junctional rhythm is hence common in this group. Junctional rhythm can conduct both anterogradely, to the ventricles, and retrogradely, back to the atrium. When it conducts retrogradely, it is termed as atrial echo, which can further conduct back to the ventricle. Our patient had a junctional rhythm with atrial echo beats that conduct to the ventricle, along with an ectopic atrial focus that does not conduct to the ventricle. This is due to variation in the RP interval [between R wave and subsequent P wave] of the echo beat and the atrial ectopic beat with respect to the preceding QRS complex. The timing of the P wave after the QRS complex determines the refractoriness of the atrioventricular node. This exhibits a trigeminal rhythm in our patient.
Keyphrases
- atrial fibrillation
- catheter ablation
- heart rate
- left atrial
- pulmonary artery
- case report
- magnetic resonance
- left atrial appendage
- mitral valve
- pulmonary hypertension
- lymph node
- diffusion weighted imaging
- diffusion weighted
- blood pressure
- contrast enhanced
- coronary artery
- magnetic resonance imaging
- body mass index
- pulmonary arterial hypertension
- computed tomography
- congenital heart disease
- left ventricular
- pulmonary embolism
- weight gain