SR, Second Degree AV Block Type I, Junctional Escape Beats


No clinical hx. What is the ECG interpretation?


Image 1 - 2 Leads





Image 2- Full disclosure

The rhythm is sinus at about 83 bpm. Sinus P waves are marked with red arrows.There is group-beating of the QRS complexes.  A group-beating is a "footprint" of a Wenckebach. This is a nice teaching strip because the droped beat or non-conducted P cannot be seen in lead II but visible as a tiny distortion on the T wave in V1. Second, after the dropped P wave, a junctional beat (J) can be seen manifeting as a narrow QRS with no P wave before it.  Its morphology can be seen to be different (black circle) from the rest of the QRS in lead I.The P wave is also hidden on the junctional beats and partly distorting the QRS morphology (blue arrow with asterisk)

Interpretation: SR, Second Degree AV Block Tyupe I, Junctional Escape Beats

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