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Junctional Rhythm example two



There are no P-waves seen here, and the baseline is irregular.  This indicates
atrial fibrillation, yet the R-R intervals are very regular, with a rate of 64.
Atrial fibrillation should cause irregularly irregular ventricular response.
Based on the rate and the normal QRS duration and shape, the pacemaker
of the ventricles is the junction.  The A-V node is completely blocked, and
the junctional beats are escape beats.  Any rhythm that is paced by a lower
focus, due to a failure of a higher element of the specialized conduction
system, may be called an escape rhythm.   Thus this strip shows atrial
fibrillation, A-V block (also called complete heart block), with junctional
escape rhythm.