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ACCELERATED JUNCTIONAL RHYTM WITH
ISORHYTHMIC ATRIOVENTRICULAR DISSOCIATION
IN HYPOKALEMIA PATIENT : CASE REPORT
Pangeran Akbar Syah1, Gitta Puspita2, Michael Tanaka3 , Gugun Iskandar Hadiyat4,
Chaerul Ahmad5
1General Practicioner, Arjawinangun General Hospital, Cirebon, Indonesia
2General Practicioner, Hasna Medika Hospital, Cirebon, Indonesia
3Resident of Cardiology, Departement of Cardiology and Vascular Medicine, Faculty of
Medicine Padjajaran University, Bandung, Indonesia
4Cardiologist, Hasna Medika Hospital, Cirebon, Indonesia
5Cardiologist, Departement of Cardiology and Vascular Medicine, Faculty of Medicine
Padjajaran University, Bandung, Indonesia
Introduction. :Atrioventricular (AV) dissociation is a condition in which the
atria and ventricle do not activate in a synchronous fashion but beat
independently of each other. Causes of AV dissociation are slowing of the
dominant pacemaker of the heart, acceleration of a latent pacemaker, a block, or
a combination. Other causes is due to interference, this occurs when there are
two rhytms (either atrial and junctional or atrial and ventricular) occurring at
similar rates and near simultaneously such that both anterograde and retrograde
conduction fall into each other’s refractory period, this is termed isoarrythmic
AV dissociation.
Case illustration: A 58 years old woman presented to Emergency Departement
with palpitation for the preceding 4 days. She denied any recent symtomps of
cardiac ischemia or failure.There is no history of cardiac disease, hypertention,
and diabetic mellitus in her past. She had a low intake since the palpitation
began. From the physical examination we don’t find any abnormal findings. From
the echocardiography showed normal dimensions of all chambers, normal LV
systolic function, and normal valves.. Lab examination showed normal value of
complete blood count, ureum, creatinine, but showed hypokalemia (K=3.0). A
routine 12 lead electrocardiogram(ECG) showed accelerated junctional rhytm
with isorhythmic atrioventricular dissociation. A repeat ECG after administration
of KCl and bisoprolol showed normal sinus rhythm.
Conclusion : Isorhythmic dissociation is not a common arrhythmia in the
general population, it falls under the category of ,and is a particular type of AV
dissociation. Hypokalemia may contribute to this arrhythmia in this patient, but
to know the exact etiology, holter and electrophysiology study should be
conducted.