Accelerated Junctional Rhythm

A pt with h/o of HTN, dyslipidemia and CAD is scheduled for surgery. Pt is asymptomatic and echo showed EF in the 60's.
 

 

Figure 1

This is a regular narrow complex rhythm at a rate of about 75 (1500/20 small squares). P waves are inverted in II, III and aVF and seen (almost) after the QRS complex. This is accelerated junctional rhythm. This is one of the longest times that I have seen a pt has stayed in junctional rhythm. Typically they go to junctional rhythm and then the sinus beats eventually captures the ventricles.

Figure 2

For this case, surgery went well and discharged after a few days.

#414