Escape rhythms are safety mechanisms of the heart's electrical conduction system, activated when the sinus node fails to generate impulses or when their conduction is blocked. These rhythms arise from secondary automatic foci, such as the atrioventricular node (junctional escape) or the ventricular myocardium (ventricular escape).

ECG Criteria

Junctional Escape Rhythm

  • Escape or replacement rhythm originating in the AV node, with QRS complexes identical or slightly different from those of sinus origin
  • Heart rate usually < 50 bpm

Ventricular Escape Rhythm

  • Rhythm originating in the ventricles that replaces anatomically higher rhythms that have been inhibited or blocked
  • Wide QRS (> 120 ms) and heart rate usually < 40 bpm

ECG in Escape Rhythms

Electrocardiogram showing a junctional escape rhythm

Junctional escape rhythm.

References

  1. Hafeez Y, Grossman SA. Junctional Rhythm. StatPearls. 2023.
  2. Samesima N, God EG, Kruse JCL, Leal MG, et al. Diretriz da Sociedade Brasileira de Cardiologia sobre a Análise e Emissão de Laudos Eletrocardiográficos – 2022. Arq Bras Cardiol. 2022;93(3 Suppl 2):2–19.