A competing junctional rhythm

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A competing junctional rhythm.  A sinus beat starts the rhythm.  The 2nd beat is a PVC or an aberrantly conducted PJC?  It looks like an inverted P wave follows the QRS complex on the 2nd beat.  The next three beats are junctional escape beats with inverted P waves that follow the QRS complexes.  The 6th complex arrives early, a PAC.  The rhythm then reverts back to sinus rhythm.




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