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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.