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Junctional Escape Beats example two



This strip, from the same patient, is very similar to the preceding one.  There are two instructive differences.  One is that the P-wave of the PAC seen here is clearly seen - it is not buried in the preceding T-wave.  The other is that the P-wave of the first junctional escape beat is inverted.  This is the more classic form for a wave formed by retrograde conduction.   Consider: if the wave of depolarization moves in the direction opposite that of a normal P-wave, the recorded deflection might well be opposite also.  The R-R intervals preceding the JEBs are 1.68 and 1.72 seconds, which, when averaged, indicate the intrinsic rate of the junction is 35, an unusually low rate.