The continuous lead V2 rhythm strip shows evidence of sinus node dysfunction. Following the third sinus beat (*) there is a pause followed by the occurrence of an escape junctional rhythm at a slower rate. P waves reappear (arrows), which are initially dissociated from the QRS complex, but ultimately they become associated with the QRS, resulting in 1:1 conduction.
Reproduced with permission by Samuel Levy, MD.
Graphic 78649 Version 3.0
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