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Premature Junctional Complex (PJC) and Junctional Escape Beats - Junctional Dysrhythmias.

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Part I

  • PJC’s and Escape Beats may occur for a number of different reasons i.e., diet, fatigue, stress, disease, ischemia
  • Premature complexes and Escape Beats frequently occur in bradycardic rhythms, but may occur almost any time.
  • Morphologically there is no difference between PJC’s and Escape Beats.

junctional ecg image 3

Part II

  • After reviewing the previous slide you should note that the difference is that PJC’s occur early and disrupt the underlying rhythm.
  • Escape beats typically occur when a cardiac rhythm is too slow and a backup pacemaker site initiates an electrical impulse.
  • It is fairly common that a Junctional Escape Beat will occur as the first complex to terminate Sinus Arrest


  • This early impulse causes an early cardiac complex which disrupts the underlying rhythm.
  • The locus of stimulation being different, results in a change in the morphology of the P wave (inverted if it can be seen).
  • PJC’s can occur occasionally or frequently.
  • PJC’s can be observed with or without a pattern
  • The P wave with PJC’s may occur before or after the QRS complex or be buried within the QRS.

Authors and Reviewers

Authored by Thomas O'Brien
Medically reviewed by Dr. Jonathan Keroes, MD, Cardiology
Last Update: 11/8/2020

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