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Premature junctional complexes (PJCs)
Premature junctional complexes (PJCs) are
premature depolarizations from the AV node or the proximal portion of the
His-Purkinje system (more common). PJCs most often occur in the absence of structural
heart disease but may occur also in clinical settings similar to those surrounding
Depolarization usually arises from the His-Purkinje system and
can be triggered by alcohol ingestion, tobacco, or adrenergic
stimulants. AV junctional complexes are less common than either
atrial or ventricular premature complexes and are more often
associated with cardiac disease or digitalis intoxication.
They usually do not lead to symptoms. In some they can lead to
palpitations and on rare occasions, cannon a waves (synchronous
contraction of both atria and ventricles). Cannon a waves can lead
to distressing pulsations in the neck.
PJCs typically result in a premature, normally conducted QRS. It
can be recognized by absence of the P wave preceding the QRS
intact retrograde AV nodal conduction, an inverted P wave will occur during
or just after the inscription of the QRS. The next, normally timed sinus
P wave may experience delay or block in the AV node, owing to retrograde
conduction of the PJC.
If symptomatic, therapy should be directed toward correction of underlying
abnormalities. Beta-adrenergic antagonists or calcium channel antagonists may be
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