"AV Nodal Arrhythmias" by Christine LaGrasta, MS, RN, CPNP PC/AC, for OPENPediatrics

Author: OPENPediatrics

AV Nodal Arrhythmias, by Christine LaGrasta. Welcome to today's module on arrhythmias. My name is Christine LaGrasta. I work at Children's Hospital, Boston, as a pediatric nurse practitioner. Rhythms originating in the atrioventricular, or AV node, include Junctional Escape, or Nodal Rhythm, and Junctional Ectopic Tachycardia, or JET. Characteristics of atroventricular rhythms are, P waves may be absent, or if present they can occur after the QRS complex and are inverted. The QRS complex is usually normal in duration and configuration.

Junctional escape, or Nodal Rhythms: the rhythm looks like sinus rhythm, but with an abnormal P wave. When the P wave does not look like a sinus P wave, the impulse is not originating in the SA node. The P wave is usually inverted, and may occur before, during, or after the QRS complex. The heart rate in the infant is less than 120 beats per minute. And in the child, is less than 70 beats per minute. Causes include any surgical procedure involving the atria. And treatment is atrioventricular sequential pacing, to restore AV synchrony. Junctional Etopic Tachycardia, or JET, is a repetitive firing of an electrical impulse, that originates from a single focus in or near the AV node.

The heart rate is 180 to 200 beats per minute. Causes: this rhythm is only seen in post-operative cardiac surgical patients. It occurs frequently after Tetralogy of Fallot repair. And treatment focuses on decreasing the patient's catecholamine response to surgery, by cooling to the patient to 35 degrees Celsius, administering sedation and muscle relaxants, and weaning isotropic infusions such as dopamine and epinephrine. A procainamide infusion can be given to decrease the fast heart rate. Please help us improve the content by providing us with some feedback.

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