Premature junctional complex

Background

WPW with PJC underlined in red

• Less common than PVCs or PACs
• Differentiate from WPW (short PR)
• May be seen in healthy individuals with no clinical significance
  • May also be seen in pathology such as valvular disease, drug toxicity, electrolyte abnormalities

Clinical Features

• Generally asymptomatic
• May cause palpitations

Differential Diagnosis

Palpitations

• Arrhythmias:
  • Narrow-complex tachycardias
  • Wide-complex tachycardias
  • AV blocks
    • Second Degree AV Block Type I (Wenckeback)
    • Second Degree AV Block Type II
    • Third Degree AV Block
  • Premature atrial contraction
  • Premature junctional contraction
  • Premature ventricular contraction
  • Sick sinus syndrome
  • Wandering atrial pacemaker
• Non-arrhythmic cardiac causes:
  • Acute coronary syndrome
  • Cardiomyopathy
  • Congenital heart disease
  • Congestive heart failure (CHF)
  • Mitral valve prolapse
  • Pacemaker complication
  • Pericarditis
  • Myocarditis
  • Valvular disease
• Psychiatric causes:
  • Panic attack
  • Anxiety
  • Somatic Symptom Disorder
• Drugs and Medications:
  • Alcohol
  • Caffeine
  • Drugs of abuse (e.g. cocaine)
  • Medications (e.g. digoxin, theophylline)
  • Tobacco
• Misc
  • Anemia
  • Hyperthyroidism
    • Thyroid storm
  • Pulmonary embolism
  • Dehydration
  • Sepsis
  • Pheochromocytoma

Evaluation

• EKG
  • P wave is either: Absent, Abnormal with PR < 120ms, OR Retrograde, which may be inverted in inferior leads
  • PJC arrives before next sinus beat
  • Followed by compensatory pause
  • From AV node region, with ventricular response usually normal, so QRS complexes usually narrow
  • If conduction is abnormal, may have right bundle branch block morphology

Management

• Depends on etiology and symptoms

Disposition

• Based on etiology and symptoms

See Also

• ECG (Main)