Sudden PR interval prolongation due to concealed conduction

 
Figure 1 - ECG case
 
An adult patient admitted for altered mental state.
What is the probable reason of the prolongation of the PRI (red
arrow)?
 
Answer: Concealed retrograde conduction of a premature junctional beat delaying AV conduction (prolonging a PR interval)
 
 
Figure 2 - ladder diagram

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