Junctional Tachycardia

Reviewed by James Beckerman, MD, FACC on February 25, 2020

Tachycardia is when your heart beats faster than normal, even when you’re not doing anything.

Junctional tachycardia is a form of supraventricular tachycardiaa type of racing pulse caused by a problem in the area between the upper and lower chambers of your heart. It’s known as the atrioventricular node, or AV node.

Symptoms

Symptoms can include:

Causes

An issue with your heart’s electrical wiring system can lead to junctional tachycardia. You may be born with it, or it might happen later. Drug use or anxiety could trigger the condition. In some cases, an injury during heart surgery may be the cause.

Diagnosis

The doctor will ask about your health history and symptoms. They’ll do an electrocardiogram -- sometimes called an EKG or ECG -- to look at the electrical pulsing of your heart. They’ll also look for signs that your AV node has taken over the rhythm-setting job of the heart. That’s normally the sinus node’s job.

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Your doctor might do more tests to rule out other causes. These could be heart and thyroid conditions, or mental health issues such as anxiety. The tests include:

  • Blood tests to check for conditions like heart disease
  • A Holter monitor to track heart activity for 24 hours or more
  • Chest X-rays for pictures of your heart and lungs
  • Echocardiograms to check your heart’s size, strength, and ability to pump

If surgery caused your junctional tachycardia, symptoms will typically show up 6 to 72 hours after the procedure. Special machines in the hospital will spot it. Your doctor might also notice a fall in both blood pressure and the heart’s pumping power.

Treatment

Your doctor might suggest a “wait and see” approach if your symptoms aren’t causing major problems. Try to avoid triggers like nicotine, alcohol, and caffeine. They may also tell you about these treatments:

At-home treatments. There are movements that may help lower your pulse during an episode. You doctor can show you how to do them. They include:

  • Dive reflex. This is when you quickly put your face into water, especially cold water.
  • Valsalva maneuver. This is kind of like straining during a bowel movement: You attempt to push air out of your lungs while you block the flow at your throat or nose.
  • Carotid sinus massage. This is gentle pressure on your neck, where the carotid artery splits into two branches.
  • Eyeball massage. Press gently on your eyes while they’re closed.

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Medication. In some cases, prescription drugs like calcium channel blockers, amiodarone, digoxin, beta-blockers, or calcium channel blockers can help lower your pulse.

Catheter ablation. If your symptoms don’t get better, your doctor might suggest a procedure called catheter ablation. It’s also known as radiofrequency ablation. This is when doctors use radio waves to destroy a tiny bit of heart tissue in the area that might trigger your tachycardia. It takes 2 to 4 hours. You usually go home the same day. Catheter ablation is typically safe. But it could damage blood vessels or lead to infection.

WebMD Medical Reference

Sources

SOURCES:

American Heart Association: “Tachycardia: Fast Heart Rate,” “Ablation for Arrhythmias.”

Arrhythmia Alliance: “Inappropriate Sinus Tachycardia.”

Cedars Sinai: “Inappropriate Sinus Tachycardia.”

Journal of the American College of Cardiology: “Inappropriate Sinus Tachycardia.”

Johns Hopkins Medicine: “Paroxysmal Supraventricular Tachycardia (PSVT).”

Mayo Clinic: “Supraventricular tachycardia.”

Merck Manual: “Paroxysmal Supraventricular Tachycardia (SVT, PSVT).”

Stanford Health Care: “Medications to Treat SVT.”

UpToDate: “Narrow QRS complex tachycardias: Clinical manifestations, diagnosis, and evaluation.”

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