When the impulse originate from AV node, it is called nodal or junctional rhythm. If the rate is high, it is called junctional tachycardia. Usually, it occurs due to depressed activity of SA node.
Nodal rhythm may be transient or permanent.
1. Transient—may occur in normal people.
2. Also transient or permanent nodal rhythm may occur in—
–– Digitalis toxicity.
–– Ischaemic heart disease (commonly, inferior myocardial infarction).
–– Rheumatic myocarditis.
–– Myocarditis due to any cause.

Types of Nodal Rhythm:

• High-nodal rhythm—small inverted P wave before QRS (simulate low atrial ectopic).
• Mid-nodal rhythm—P is not seen (buried in QRS).
• Low-nodal rhythm—P is present after QRS.
ECG Findings
• Heart rate—40–60/minute.
• P—small, inverted (P may not be seen, buried in QRS or after QRS).
• PR interval—short.

Treatment of Junctional Rhythm

Treatment of primary cause.