Figure 18. Junctional rhythm. Impulses originate in the AV node or AV junctional tissue, with retrograde and antegrade transmission. In this example, retrograde transmission is taking place into the atria, giving an inverted P wave. The ventricular rate is slower than with sinus rhythm and the QRS is narrow. If there is also sinus node depolarization, a normal-appearing P wave may be present. If a wandering pacemaker is present in the atria, inverted P waves can precede the QRS complex.
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