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Junctional Rhythm example one



Notice the absence of P-waves: there is no organized atrial activity seen here.
The pacemaker, by default, is the next member of the specialized conduction
system: the A-V junction.  This pacemaker provides a rhythm that is very
regular, with a rate typically around 60 (the rate in this example is 58), and
because all elements of the specialized conduction system below the junction
are in use, the QRS complexes and the T-waves are normal.  Note that the
baselineis slightly irregular.  It is possible that this junctional rhythm is an
escape mechanism from fine atrial fibrillation with complete AV nodal block.
Or, this irregularity may just be artifact, and the atria are at a standstill.
(see next page)