Sometimes you see an ECG and feel overwhelmed at first. This ECG rhythm strip is challenging at first glance. However, if you take a systematic approach to the analysis, it is usually possible to decipher the case.
The solution refers to the numbers in the second ECG:
Beats 1 and 3 are sinus
Beat 2 is a PVC
Beats 4 and 5 are a PVC couplet; the second one has managed to conduct retrogradely and produce a P wave, which resets the sinus node.
Beat 6 is a sinus P Wave with a junctional escape beat just after it (not conducted)
Beat 7 is a PVC
Beats 8, 10, and 12 are sinus
Beats 9 and 11 are PVCs