This is an example of a junctional rhythm that is slower than what is considered "intrinsic rate" for the junction. The rate is around 30 bpm. We know this is a "supraventricular" rhythm because of the narrow QRS. Junctional beats travel to the ventricles via the bundle branches, which provides very fast conduction, resulting in a narrow QRS complex. The P waves can be seen at the end of each QRS. They are upside-down in this Lead II rhythm strip, indicating retrograde conduction from the junctional pacemaker to the atria.
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