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Junctional Escape Complexes that Follow Premature Atrial Complexes that Reset the SA Node

Description

The rhythm is best interpreted in the lead II rhythm strip. The origin of the first QRS complex is unknown since there is insufficient recorded electrical activity prior to this complex to allow interpretation of atrial activity. The likely origin of the second and third complexes is the SA node, suggested by the upright P waves. The fourth complex is a premature atrial complex (note the different P wave morphology and the shorter R-R interval). It is followed by a longer R-R interval and a junctional escape complex. The cycle of a premature atrial complex that resets the SA node, lengthening of the following R-R interval and a junctional escape complex then repeats throughout the remainder of the recording. An additional finding is right bundle branch block.

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