Recommendations for Ongoing Management of Atrial Flutter (Continued) COR LOE Recommendations 8. Junctional Tachycardia See Figure 20 for a representative ECG for junctional tachy- cardia and Figure 21 for the algorithm for ongoing manage- ment of junctional tachycardia. Junctional tachycardia is a rapid, occasionally irregular, narrow-complex tachycardia (with rates typically of 120 bpm to 220 bpm) (Figure 20). AV dissociation (often isorhythmic) may be seen, and when present, excludes the misdiagnosis of AVRT and makes AVNRT highly unlikely. Other SVTs are often misdiagnosed and misclassified as junctional tachycar- dia because of the frequent absence of demonstrable P waves in reentrant rhythms. Furthermore, when it is irregular, junc- tional tachycardia may be misdiagnosed as AF or MAT. The mechanism for junctional tachycardia is enhanced (abnormal) automaticity from an ectopic focus in the AV junction (includ- ing the His bundle).388 Junctional tachycardia is uncommon in adults388 ; it is typically seen in infants postoperatively, after cardiac surgery for congenital heart disease; this is also known as junctional ectopic tachycardia. As such, there is limited evidence with regard to diagnosis and management of junctional tachycardia in adult patients. Adults with junctional tachycardia typically have a relatively benign course, whereas infants and children with acquired or congenital junctional tachycardia have a high rate of death due to heart failure or an uncontrollable, inces- sant tachyarrhythmia. There are data to support the use of beta blockers, diltia- zem, flecainide, procainamide, propafenone, and verapamil for the treatment of junctional tachycardia (see recommenda- tions and references in Sections 8.1 and 8.2). The efficacy of amiodarone has been reported only in pediatric patients.389,390 Digoxin has not been well established as chronic therapy for junctional tachycardia. 